Peter Harbage

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