CMA Capitol Insight: Not Immune

February 18, 2014
Area(s) of Interest: Access to Care Advocacy Health Care Reform 

CMA Capitol Insight is a biweekly column by veteran journalist Greg Lucas, reporting on the inner workings of the state Legislature.

Not Immune

Despite leading other states in both sign-ups and reliability, Covered California had a notable glitch the other day. The state marketplace for health insurance under the Affordable Care Act said that the website for the act’s Small Business Health Options Program, known as SHOP, would be going offline until at least the fall in order to “implement a series of redesigns” that Covered California hopes will “increase the efficiency of service and allow better management of applications, including determination of eligibility, implementing group changes and issuing invoices.” Says Covered California’s Executive Director Peter V. Lee: “The SHOP portal was not meeting the needs of agents or small employers and needed improvements.” While Covered California’s blandness in announcing the at least six-month closure of the site suggests more happening than merely a need for speedier invoices, it could also just be Bureaucratese, a language in which the state and any number of other government agencies are fluent. The site shutdown was mentioned in the media but generated nowhere near the heavy breathing other website snafus at the federal government’s site or those of other states generated in the early days of registration, way back in October. There are several reasons for this. 1) It didn’t happen at the time of initial implementation when the media was focused on the Affordable Care Act and eager to puff up any hiccup or stumble into Page One significance; and 2) It ain’t that big of a deal. Since October, more than 1.8 million enrollment applications have been started through Covered California’s marketplace. SHOP is a second marketplace aimed exclusively at employers of 50 persons or less and their employees. Through the end of January, the last period for which Covered California has stats, 571 groups – nearly 4,500 persons – were enrolled in SHOP with an additional 200 group applications, covering 1,200 individuals, in the SHOP pipeline. Is that because of the website deficiencies? Maybe. But it doesn’t appear to be. Covered California says while the website is getting rejiggered, applicants can carry on the old-fashioned way – using paper. (Welcome news to insurance brokers, no doubt.) Reading further in the Covered California press release it notes “the vast majority of SHOP enrollments have been submitted using paper applications.” Maybe the modest media coverage was just about right.

Flu Deaths

The number of influenza-related deaths in the state has increased by 41 to 243 confirmed deaths for the 2013-14 season, according to mid-February stats released by Ron Chapman, M.D., director of California Department of Public Health. Four of the 243 are babies. Another 41 deaths are being investigated but not yet confirmed as influenza-related. This time last year, the state Department of Public Health logged only 26 influenza fatalities. For the entire 2012-13 season, a total of 106 deaths were reported. Is it because more parents aren’t vaccinating their kids? Dr. Chapman says this: “The great majority of reported influenza deaths in persons under 65 years of age have occurred in people with underlying medical conditions. Looking at the onset of illness, the number of deaths by week appears to be decreasing. Both outpatient visits and hospitalizations have decreased and hospitalizations are within levels that would be expected at this point in the season.” That’s good but almost 10 times more deaths this year than this time last year? That still seems exceptionally high. Here are counties with flu-related deaths in the double-digits: Fresno, 17; Kern, 10; Los Angeles, 33; Sacramento, 23; San Bernardino, 18; San Diego, 19; Santa Clara, 12; and Stanislaus, 13. Orange County reported nine deaths. Alameda and Contra Costa each reported six deaths. San Francisco reported three.

Bridge Bragging Rights

The western span of the Bay Bridge – the part that connects San Francisco with Treasure Island – is now named after Willie Lewis Brown, Jr., both a former Speaker of the California Assembly and mayor of what San Francisco Chronicle columnist Herb Caen routinely called “Baghdad by the Bay.” To celebrate the bridge’s new name and the person who provided that name, Brown – 80 on March 20 – hosted an event recently on what would have been his mother’s 105th birthday. While the state’s stated policy is that if some part of the transportation system is named after a person, it must be a memorial, Brown proved conclusively that he is, indeed, very much alive and said he plans to enjoy “his” bridge to the fullest for the maximum amount of time possible. The self-proclaimed “Ayatollah of the Assembly” for 15 years, Brown will likely go down in history books as California’s longest serving speaker since term limits prevent any lawmaker from being in the Legislature longer than 12 years. Brown told the crowd of 300 that naming the second most trafficked bridge in the country after him had bipartisan appeal. Brown said a “cat on the street” accosted him and volunteered that Brown’s liberal political philosophy was abhorrent and that Brown himself wasn’t all that likable either. However, the man added, he was happy a bridge was named for the former mayor because he was going to enjoy “rolling over” Brown daily. Brown also recounted how after giving a speech at a neighborhood elementary school, a group of school children stopped him. One of the kids said: “Hey Mister, who did you used to be?” Brown said that henceforth he plans on responding: “I’m a bridge.” (Taxpayers don’t foot the bill for the “vanity” highway signs, the honorees do – about $1,200 a sign.)

The Final Indignity

Shortly after it was announced she would be the next speaker, Assemblywoman Toni Atkins, a San Diego Democrat, introduced a bill to better ensure that a transgender person has the gender they identify with appear on their death certificate rather then the gender they had at birth. It’s one of four bills pending in the Legislature sponsored by Equality California, an advocacy group for gays, lesbians, bisexuals and transgender persons. How often do these death certificate mistakes happen? Of California’s 38 million residents, the transgender population is roughly 0.2 percent, according to the Los Angeles County Department of Public Health in 2012 when it tried to estimate the number of transgender persons living in the state’s most populous county. However, as Atkins says: “For transgender people, their gender identity may not be consistently recognized after death by family, friends and even officials. This bill provides an objective way to make sure that a transgender person’s gender will be correctly identified after they pass on.” Equality California says the genesis of the bill is the case of Christopher Lee, a San Francisco artist and transgender advocate who was “mis-gendered” after his death in 2012. Lee was born female but “had long identified and expressed himself as a transgender man.” The coroner wrongly identified Lee as female on his death certificate, despite his driver’s license showing his sex as male. Atkins’ bill says that a transgender person’s death certificate should show that person’s gender identity if there’s documentation of that gender identity, such as “written instructions from the deceased confirming their wishes, an updated birth certificate or driver’s license or evidence of medical treatment for gender transition.” Transgender people frequently face significant barriers in getting identity documents changed. Last year, Atkins won a signature from Gov. jerry Brown on a bill making it easier for transgender persons to have documents like birth certificates updated to accurately reflect their gender.

 An Apt Description of the Last Half Century

How much has happened in these 50 years—a period more remarkable than any, I will venture to say, in the annals of mankind. I am not thinking of the rise and fall of empires, the change of dynasties, the establishment of governments. I am thinking of those revolutions of science, which have had much more effect than any political causes, which have changed the position and prospects of mankind more than all the conquests and all the codes and all the legislators that ever lived.” Even truer today than when Benjamin Disraeli said it in November 1873.


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