Peter Harbage: All Publications, Events and Press

Peter Harbage in San Jose Mercury News | 'Committee Kills Health Plan'

Communications — Mon, 28 Jan 2008 15:28:00 -0500

Senate committee kills health care reform plan (San Jose Mercury News)

"California had a major opportunity," said Peter Harbage, an independent health care consultant affiliated with the New America Foundation think tank. "This would have been one of the biggest reform efforts in the nation in a very long time, really since the Clinton effort" in the mid-1990s.

Why the Budget Gap Shouldn't Derail Health Care Reform

adminn — Tue, 15 Jan 2008 15:06:00 -0500

As Gov. Arnold Schwarzenegger has released his budget threatened by $14 billion of red ink, many are asking whether California can afford the ambitious health care reforms that passed the state Assembly in December. Given the social and economic costs of leaving as many as 6.5 million Californians uninsured, the better question may be: Can we afford not to?

Those worried by the possible impact of the budget gap on health reform include Senate President Pro Tem Don Perata, whose chamber must vote for the health reform bill for it to move forward. Perata's concerns must be taken seriously. It would be hard to justify cutting back some social services while enacting a seemingly expensive health care plan.

But these doubts miss the larger picture: Health care reform will strengthen the economy, improve productivity and reduce long-run deficits. Over time, it actually costs more to let California continue to have one of the highest rates of un-insurance in the country than it would cost to cover everyone. The harm to individuals, business -- and ultimately the state's bottom line in terms of total social cost -- is unacceptable.

The most compelling reason to cover the uninsured remains the personal toll paid by those without coverage, and their families. The burden of medical costs, for example, is a major contributor to personal bankruptcies. Being uninsured leads to poorer health. A recent study by researchers at the Harvard Medical School found that previously uninsured Americans slowed declines in their health when they became eligible for Medicare. The American Cancer Society has linked lack of insurance coverage to later screenings for cancer and lower survival rates. A recent update to a report by the prestigious Institute of Medicine estimates that about 22,000 Americans, or roughly 3,200 Californians, die each year as a direct result of lacking health insurance.

Another IOM study calculated that the lost human capital related to lack of health insurance -- including lost earning potential and the value of extra years of life -- is as much as $170 billion nationally, updated to 2006 numbers, or about $26 billion for California's share. To be sure, this foregone value doesn't immediately translate into rosier budget projections. But it needs to be pointed out that covering the uninsured isn't only about absorbing new public costs but also about investing in future productivity gains and economic growth.

The insured are paying a hidden tax for the care of the uninsured, as the New America Foundation has frequently pointed out. Patients without coverage often allow basic medical conditions to go untreated. When their hope of getting better fades, they go to the emergency room where they receive the most expensive care available to treat their now serious conditions. When their bills go unpaid, the costs are passed on to Californians with insurance, increasing the cost of private health insurance by almost 10 percent.

The cost-containment measures in the governor's plan -- including requirements that hospitals disclose cost and quality information - are a good first step toward getting health costs under control, making premiums more affordable and getting more bang for the health care buck. As a study released last year by the McKinsey Global Institute in San Francisco showed, even after adjusting for relative wealth, the United States spends hundreds of billions more on health care than other countries and delivers no better, and often worse, health outcomes.

Health-care reform promises to offer some relief for California's chronic structural deficit. State health spending is the fastest-growing area in the budget, rising almost 9 percent annually on average in recent years. Drawing on the tested example of other states, the reform proposal would bring in an estimated $4 billion in new revenues from the federal government for Medi-Cal, the state health program that covers almost 7 million Californians with low incomes. Shared responsibility for health funding will prevent individuals and employers from shifting their costs onto taxpayers.

Moreover, the California health reform bill identifies its own funding, including a tobacco tax, levies on businesses that fail to purchase health insurance for their employees, and individual premiums. This financing would have to be approved by voters and wouldn't go into effect until 2010, well after this year's budget debate.

From a fiscal standpoint, there will never be a perfect time to reform health care. The state's budget is chronically in crisis and lawmakers have perfected the habit of just getting by. But every day we delay in starting a new system actually damages our economy over the long-run and reduces our quality of life. If European countries, for example, could rebuild their health care systems to provide universal coverage out of the rubble of World War II, certainly California can strengthen our private health care system now.

Why the State's Budget Gap Shouldn't Derail Health Care Reform

Health Policy — Tue, 15 Jan 2008 14:47:00 -0500

On January 15, 2008, the San Francisco Chronicle featured an opinion piece authored by Leif Wellington Haase and Peter Harbage of the New America Foundation. The article, titled “Why the state’s the budget gap shouldn’t derail health reform,” presented several statistics on the importance of health reform. This background and analysis document offers the underlying support for the statistics used in their argument.

New America Welcomes Historic Vote on California Health Reform

Jerry Irvine — Mon, 17 Dec 2007 20:42:00 -0500

Len Nichols, Director of the Health Policy Program at the New America Foundation, made the following statement today after the California Assembly voted to approve health care legislation that would cover all Californians. New America has provided policy and communications advice to Governor Schwarzenegger, his staff, and to Democratic leaders throughout the reform debate. Many of New America’s core health reform principles, including an individual mandate, are included in the proposal:

“Today is an exciting day for Californians, and for all Americans. This historic Assembly vote encourages us to believe that creating a system of coverage for all Americans is possible. The growing momentum for comprehensive health reform is real.

Amidst the most partisan political atmosphere in recent memory, a Republican governor and Democratic legislators reached common ground and linked together their respective visions. This bipartisan spirit is a model for our nation. It should inspire lawmakers in Washington to move beyond rhetoric and have a serious bipartisan conversation about health reform.

The Governor’s shared responsibility approach means that everyone must play a role in implementing and sustaining health reform. Likewise, this victory belongs to the many groups who united around the common goal of covering all Californians. It could not have been achieved without the commitment and mutual respect shown by the Governor, Assembly Speaker Nunez, and Senate President Perata. We hope the Senate will follow suit and build on this accomplishment.

There is much work left to be done in California. However, it is clear there is a growing consensus that our health system is in need of serious repair and that sustainable reform will take a bipartisan effort. As the country debates how to cover all Americans, California is leading the way toward comprehensive health reform.”

Video of this event, as provided by Gov. Schwarzenegger's office, is available below.

Peter Harbage Interviews with KCRW's Which Way, L.A.?

Communications — Wed, 10 Oct 2007 05:33:00 -0400

In January, Governor Schwarzenegger made national headlines by proposing universal health insurance in California and there was talk of creating a national model. After months of wrangling in Sacramento, he offered a legislative proposal yesterday. It would still require that every Californian buy health insurance. It would change the formulas for employer participation. The big news has to do with the state lottery. ... $37 billion could be raised by it and some of the money could be allocated to healthcare.

"... Everyone is still looking for ways to keep healthcare affordable. ....The lottery is another piece of that debate," said Peter Harbage, a Senior Program Associate of the Health Policy Program at New America Foundation.

"... The only way to achieve universal coverage is by having an individual mandate. ... The individual can't be alone in this, there needs to be shared responsiblity. ... There need to be a lot of changes to the system in order to have insurance. ..."

To listen to the show, please click on the Mp3 attachment below, or visit KCRW's website.

Peter Harbage in Sacramento Bee on Bush's Veto of SCHIP

Communications — Sun, 07 Oct 2007 08:42:00 -0400

President Bush's veto of a bill that would have allowed California to achieve near-universal health care for children comes at a critical juncture in the state.Employer-based coverage is decreasing, enrollment in the state's Healthy Families program is increasing and efforts by Gov. Arnold Schwarzenegger and Democrats to overhaul the health care system have not yielded a solution a month into a special legislative session.Moreover, new Bush administration rules would make it harder for California to enroll children from middle-income families in Healthy Families."For Schwarzenegger and (Democrats), Healthy Families is a big part of health reform," said Peter Harbage, a consultant who has prepared a study for the California Healthcare Foundation on the possible impact of reduced funding from the federal State Children's Health Insurance Program.SCHIP provides $2 for every $1 the state spends on its Healthy Families program for children. But a $60 billion, five-year extension of SCHIP approved by Congress with bipartisan support was vetoed last week by the president...

Peter Harbage is a Senior Program Associate at New America Foundation. For a direct link to this article, please visit the Sacramento Bee website.

New America Foundation Releases a Paper on Key Health Reform Component

Communications — Thu, 13 Sep 2007 15:03:00 -0400

The New America Foundation today released "Coverage Without Gaps: Implementing Seamless Health Insurance Coverage," a policy report on its model of seamless health insurance that would create a health insurance system where, once coverage is affordable and accessible, Californians would be required to purchase it. Seamless coverage would make universal health coverage a reality in California.

A requirement to purchase insurance is an active part of the ongoing health care reform debate in California. It is a key feature of Governor Schwarzenegger's proposal, and it will likely be a key issue considered in the California Legislature’s special health care session. Based on personal plus shared responsibility, seamless coverage will ensure that no families or individuals fall through the cracks by reforming the insurance market, developing automatic insurance enrollment, and sharing the financial risk.

"Seamless coverage is both a requirement and a promise that no Californian will ever lack access to the health care they need and deserve," said Peter Harbage, senior policy associate with the Foundation. "Shared responsibility means that the individual must take action to enroll in health insurance while the government and employers must help make insurance affordable and automatic."

In “Coverage Without Gaps: Implementing Seamless Health Coverage in California,” the New America Foundation proposes a set of principles and steps to achieve universal coverage:

Access and Affordability. As polls show, Californians want affordable and comprehensive health insurance, which can be achieved with a reasonable combination of subsidies, automatic enrollment and insurance market reforms. In a reformed insurance system that is open and affordable, most people will choose to enroll. The plan also calls for the state to create a public pool open to all those without access to employer insurance.
Review and Monitor Enrollment. The state must review health insurance enrollment consistently and in a timely manner so that individuals without insurance can be given the support they needed to find and keep insurance.
Fair Penalties. The state must enforce reasonable penalties against the few who can afford to pay their fair share and simply refuse to do so.

"Requiring individuals to take responsibility for their own health coverage, with appropriate support, is the only way to achieve universal coverage," said Len Nichols, director of the New America Foundation Health Policy Program.

The New America Foundation model of seamless health insurance coverage is based on the idea, shared by many experts, that universal coverage can only be achieved through an individual mandate. New America's paper "Growing Support for Shared and Personal Responsibility in Health Care,” provides support for this view. To help achieve seamless coverage, New America analyzed the lessons and history of auto insurance requirements around the country, and detailed those in a paper "What Your Car Can Teach You About Health Reform.” For more information on Seamless Heath Insurance Coverage, please click on the following link: Seamless Health Insurance Coverage.

Coverage Without Gaps

Health Policy — Thu, 13 Sep 2007 08:24:00 -0400

In America’s fragmented health care system, too many individuals and families lack continuous access to health insurance. Overwhelming evidence shows that lacking health insurance leads to decreased access to quality care and reduces health status. The widely shared social and economic losses from these problems compound the cost of thousands of lives lost every year due to lack of health insurance and consequently access to care. In this context, health reform that ensures every individual and family seamless health insurance is more a matter of stewardship than of charity.

The goal of California health reform should be seamless, universal coverage, achieved by sharing responsibility among government, businesses, and taxpayers. This goal is achievable if we develop a system that encourages people to enroll by removing barriers and making insurance affordable. While all individuals must participate, seamless coverage should focus on ensuring that no individual or family is allowed to fall through the cracks, not just enforcement. Financial risk should be fairly shared by government, business, and households.

This paper develops operational principles and techniques to help California (and any system, by extension) create a culture of coverage where having health insurance is the norm and lacking insurance is the rare exception.

Both the full paper and an executive summary are available below in PDF format.

L.A. Times Reports on Hospitals' Embrace of New America's Plan

Communications — Fri, 07 Sep 2007 12:06:00 -0400

Gov. Arnold Schwarzenegger won an important ally Thursday in his effort to overhaul the state's healthcare system, as California's private hospital industry agreed to a $1.7 billion tax on itself.

The tax, which would require voter approval, would help cover the cost of providing health insurance for all Californians, which the governor said was his goal for the year.

The tax money, along with federal funds and a $600-million tax on public hospitals, would create a $4-billion pot of money that would then be returned to hospitals based on how many poor people they treat.

Most hospitals would end up with more money than they paid in the tax, although some would end up with less.

"It's a very significant deal," said Peter Harbage, a senior program associate with the New America Foundation, a think tank with offices in Washington, D.C., and Sacramento. Schwarzenegger based his proposal on some of the ideas endorsed by the foundation...

For the complete article, please visit the Los Angeles Times web site.

Harbage in the Ventura County Star on Schwarzenegger's Health Reforms

Communications — Sat, 18 Aug 2007 05:26:00 -0400

SACRAMENTO — There are 4.1 million New Yorkers who get healthcare coverage under Medicaid, the federal safety net for the poor. For each of them, Uncle Sam spends an average of $5,891 a year.

In California, there are 6.5 million low-income people who rely on the same program. For each of them, Uncle Sam spends just $3,419.

Who makes up the difference?

To a large degree, health policy experts say, it is Californians with private insurance: They pay higher premiums to backfill the losses incurred by doctors and hospitals that lose money by treating poor patients insured by the government.

The clock is ticking toward the deadline for enacting major healthcare reforms before the Legislature adjourns next month. New attention is being focused on one element of Gov. Arnold Schwarzenegger's proposed reforms that has been largely overlooked — tapping into a pool of up to $2 billion in federal money that could help reinvigorate what the governor calls the state's "broken healthcare system."

"The money's there, if the Legislature acts," said Health and Human Services Secretary Kim Belshé.

There is, however, a catch: In order to access the money, the state would have to… more

Sacramento Bee Cites Peter Harbage on CA Health Care

Communications — Sun, 29 Jul 2007 09:42:00 -0400

A debate winding to a close in Washington could undermine ambitious health care proposals by Gov. Arnold Schwarzenegger and Democrats in the Legislature that would provide coverage to every uninsured child in California.The State Children's Health Insurance Program, or SCHIP, a bipartisan compromise created a decade ago from the embers of the Clinton universal health care plan, expires on Sept. 30.As federal lawmakers prepare to leave this week for a monthlong summer recess, the U.S. Senate and House are grappling with separate bills that would dramatically increase SCHIP funding to states -- the Senate by $35 billion over five years, the House by $50 billion -- by raising tobacco taxes...But President Bush has threatened to veto both congressional bills and instead has proposed a $5 billion increase in funding over five years.A recent study by a research team led by Peter Harbage of the New America Foundation found California alone would need an additional $4.2 billion during that period to cover eligible children...

For the complete article, please visit The Sacramento Bee website.

What Your Car Can Teach You About Health Reform

Health Policy — Mon, 09 Jul 2007 08:03:00 -0400

Analysts largely agree that if you want everyone to have health insurance, you’re going to have to require it. “Individual mandates” to purchase health insurance would also help insurance markets work better than they do now, since insurers would then find it far easier to attract a balance of high and low risks if all had to buy something. Therefore they would need to do far less medical underwriting (risk evaluation) and targeted marketing, and that would lower the cost of insurance to us all. And of course, if all patients had good insurance, then hospitals and doctors would have to worry less about charging Peter to pay for uninsured Paul and thus be able to devote more time to high quality patient care.

But this all works only if the mandate actually works, that is, if the purchase requirement is indeed enforceable in the real world. Critics of such a requirement have often argued that such a requirement will prove relatively unsuccessful, just like the current requirement for motorists to purchase auto insurance.

Though California has seen high rates of uninsured motorists despite three decades of legislation mandating that drivers buy auto insurance, health care reformers can learn valuable lessons from new changes underway at the California Department of Motor Vehicles. The successful efforts at California DMV and in other states demonstrate that there are models for how an individual requirement to purchase health care can be successfully implemented.

For the full fact sheet, please see the attached PDF document below.

California Event: Ensuring Seamless Insurance Coverage For All

Communications — Wed, 04 Jul 2007 19:28:00 -0400

A New America Event
07/09/2007 - 3:30pm

The Legislature, Governor Schwarzenegger and key health care stakeholders are deep in discussions on how to reform California’s broken health care system, including how to reduce the number of uninsured Californians. At this event, New America Foundation Health Policy Program Director Len Nichols and Peter Harbage discussed how to use the principles of seamless coverage and shared responsibility to create a process to ensure all Californians have health coverage, including what we can learn from recent successful experiments in… more

Growing Support for Shared and Personal Responsibility in Health Care

Health Policy — Sat, 30 Jun 2007 08:54:00 -0400

Fear is a powerful force. Families fear the disappearance of affordable health insurance, employers fear international competition while financing high and rising health care costs at home, and providers fear that they will not be able to deliver needed care for lack of funding. In short, just about everyone fears that our system will fall apart. Instead of taking action, many politicians remain fearful of tackling health care reform, since it crushed the Clintons and others before them.

But hope is an equally powerful force. And the hope is that there is growing bipartisan support for a health system based on shared responsibility -- with the individual, employers, and government all doing their fair share.

Shared responsibility with an individual requirement to purchase coverage is not a new idea. Leading academics and 16 Republican senators proposed an individual mandate approach to universal coverage during the Clinton era. But renewed interest has intensified since Ted Halstead and Michael Lind published their ideas about how it could be done in The Radical Center in 2001. Since then, an impressive array of thinkers and analysts has shared quite similar visions. We collect and publish their statements and provide references in this paper.

For the full paper, please see the attached PDF below.

Hoover Insitution Confirms that Insured Californians Pay 'Hidden Tax' for the Uninsured

Communications — Mon, 21 May 2007 11:58:00 -0400

SACRAMENTO, CA (May 21, 2007) -- Insured Californians pay a "hidden tax" for the uninsured, a study released today by the Hoover Institution confirms. However, an analysis by the New America Foundation finds that the Hoover study underestimates the size of this tax. The New America analysis shows that the reasonable range of estimates of the "hidden tax" is between 6% and 11%, but the Hoover Institution's estimate falls well below this range.

In order to provide uncompensated health care for the uninsured, providers charge higher prices to insurers, who then charge higher prices to insured families - resulting in a hidden tax. "The good news is the Hoover Institution agrees there is a 'hidden tax' that links the well-being of the insured and the uninsured," said Len Nichols, Director of the Health Policy Program at the New America Foundation.

However, the Hoover Institute's analysis contains several flaws. By assuming current Medi-Cal payment rates adequately cover provider costs, and by underestimating the number of uninsured, the Hoover Institution seriously misjudges the "hidden tax." "In downplaying the hidden tax, the study denies the need for real health reform that covers the uninsured and spends our health dollars more wisely," said Peter Harbage, Senior Program Associate based in Sacramento.

Although health analysts may debate the correct methodology for estimating cost-shifting in the health care system, they widely agree that Californians ultimately pay a significant hidden tax to cover medical care received by the uninsured. As taxpayers, all Californians pay for government funding that may go toward care for the uninsured; health care providers pay if they are not able to shift costs to insurers; and, as the analyses released today show, insured families pay through higher premiums and out-of-pocket payments.

"The New America estimate of the hidden tax withstands analytic scrutiny. The larger point is that we all help pay for the uninsured in a variety of ways, none of which are efficient or transparent," said Nichols.

Today, the New America Foundation released an analysis of the Hoover Institution study, with updated estimates of the "hidden tax." This memorandum is available on the New America Foundation website at: http://www.newamerica.net/publications/policy/estimating_the_hidden_tax.

Estimating the 'Hidden Tax' on Insured Californians Due to the Care Needed and Received by the Uninsured

adminn — Mon, 21 May 2007 10:33:00 -0400

The report released today by the Hoover Institution confirms that insured families across California pay a "hidden tax" to provide uncompensated health care to the uninsured. The existence of this "hidden tax" is no longer in dispute; what's under debate is its magnitude, which is hard to measure precisely because it is "hidden."

This memo describes the range of estimates that various experts have made, highlights some of the reasons for differing judgments, and then lets the reader draw his or her own conclusions about the reasonable range of hidden tax estimates.

For the complete Policy Memo from New America, please see the attached PDF file below. The Hoover report can be downloaded from that group's web site.

Peter Harbage in The California Report on Health Care Reform

Communications — Tue, 24 Apr 2007 12:54:00 -0400

The debate over major health care reform in California heats up this week at the state Capitol. Later today, Assembly Speaker Fabian Nunez unveils a series of major amendments to his health care legislation. Tomorrow, a plan from Senate President Don Perata will be heard in committee. As the program reports, the committee hearings are the first public action after weeks of private negotiations between lawmakers, Governor Schwarzenegger, and interest groups.

To listen to the story, please visit The California Report website.

San Jose Mercury News Quotes Peter Harbage on Blue Cross

Communications — Sun, 15 Apr 2007 14:46:00 -0400

SACRAMENTO - When Blue Cross sells health insurance to someone who isn't covered at work, the company typically makes a 27 percent profit. By the time salaries and other administrative costs are accounted for, only half the money the company collects in premiums from that person goes for medical care.Those figures may help explain why Blue Cross - the insurance provider for roughly one in four people in the state who have health coverage, and with political heft in the Capitol to match - so far is the only major insurer opposing Gov. Arnold Schwarzenegger's universal health care plan..."The idea that you have to sell health insurance to any comer is antithetical to their business model," said Peter Harbage, a health care expert at the non-partisan New America Foundation who has advised the governor. "It's not how they make money..."

For the complete article, please visit the San Jose Mercury News website.

L.A. Times Quotes Peter Harbage on Schwarzenegger's Health Plan

Communications — Wed, 11 Apr 2007 18:35:00 -0400

People who refuse to obtain health insurance could be tracked down by the state or a private contractor, enrolled in a plan and fined until they pay their premiums under one proposal Gov. Arnold Schwarzenegger's administration is considering as part of his vision for covering all Californians...Schwarzenegger wants to offer public subsidies to the least affluent Californians. But many Democratic legislators, unions and consumer advocates have objected that others will not be able to afford even the bare-bones, high-deductible plans that Schwarzenegger would require as a minimum, which cost $1,200 a person a year...Peter Harbage, a senior program associate with the nonpartisan think tank the New America Foundation, said relatively few people would have to be forced to buy insurance. Schwarzenegger has cited the foundation's research in helping to frame his plan."Most people are going to have insurance if the program is well designed and well constructed," he said in an interview Tuesday. "And then you're going to have some people who are bad actors, and that's where you need some sort of tracking system..."

For the complete article, please visit the Los Angeles Times website.

Peter Harbage on the Hidden Tax in California Progress Report

Communications — Sat, 24 Feb 2007 16:56:00 -0500

On a parallel track from the health debate raging in the legislature, the Little Hoover Commission continued its examination of state’s health landscape on Thursday, calling academics and advocates to talk about health proposals on the table. Since last year, the Little Hoover Commission, which is charged with examining ways to make state government more efficient, began looking at different aspects of the health care system late last year... The three-hour conversation on Thursday was slightly different than the other commision hearings in that it reviewed health reform through a wide lens – not just limied to public programs, even though its focus is state government. Panelists on Thursday included: • Peter Harbage, senior program associate for the Health Policy Program for the New America Foundation. • Gerald F. Kominski, Associate Director of the UCLA Center for Health Policy Research • Glenn Melnick, Professor and Blue Cross of California Chair in Health Care Finance; School of Policy Planning and Development at the University of Southern California • Anthony Wright, Executive Director of Health Access California, yours trulyAfter each presenter provided an overall statement, there was a wide ranging question and answer session… more