Capitol Alert

Californians received the bottom line Thursday on which insurance firms will sell policies on the state's new health-care exchange this fall and how much those premiums will cost.

The announcement by Covered California, the marketplace for such policies, brings into sharper focus the impact of the nation's health-care overhaul on families and their pocketbooks.

Thirteen health plans were picked to sell plans, with none of the state's 19 designated regions having fewer than three plans to serve consumers, Covered California announced.

Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser Permanente were among the firms chosen. Their tentative selection is subject to rate review by state regulators.

California's 19 geographic regions will average five health plans from which to choose. Even in most rural areas, consumers will have two or three options - though in a small number of counties only one plan will be available, officials said.

A veritable army of politically powerful but unlikely partners vowed today to jointly fight California's planned rate cut to Medi-Cal providers.

The broad-based coalition includes groups representing physicians, health plans, hospitals, dentists, first responders, and the state's largest labor union of health-care workers - Service Employees International Union.

Dr. Paul R. Phinney, president of the California Medical Association, described the gathering as an "unprecented coalition of providers of health care in our state to make sure that the Affordable Care Act is implemented in a smart and sensible way."

"Quality health care is going to be less available and less affordable in California if we continue to cut our system to the bone," Phinney said.

As the federal Affordable Care Act begins to take effect, ever-fewer California employers are offering medical insurance to their workers, according to an annual survey by the California Healthcare Foundation.

From 2002 to 2012, the proportion of employers offering such coverage declined from 71 percent to 60 percent. Meanwhile, the costs of health care insurance have risen by just under 170 percent since 2002, more than five times the overall inflation rate.

The average premium for single-person coverage was $545 per month in 2012, substantially more than the national average of $468, while family coverage cost an average of $1,386 in California and $1,312 nationally, the foundation said.

The survey also found that larger employers with high proportions of full-time workers were most likely to offer health insurance to workers and that deductibles tended to be much higher among small employers than among large ones.

Finally, 21 percent of employers reported that they had increased the share of insurance costs borne by employees during the preceding year, while 17 percent either reduced workers' costs or absorbed increases.

PHOTO CREDIT: Optometrist Aaron Lech, right, examines patient Melanie Kearns of Rocklin in his office in Roseville on April 11., 2013. The Sacramento Bee/Randall Benton

California may have high housing, fuel and electric power prices, but Californians' spending on health care is below the national average, according to a new data compilation by the Wall Street Journal.

California was spending $6,258 per resident on health care - doctors, hospitals, prescription drugs - in 2009, the latest year for which complete data were available, the Wall Street Journal study found.

That was about $600 less than the national average, with spending ranging from a high of $10,349 in Washington, D.C., to a low of $5,031 in Utah.

Overall, the data indicated that California was spending about $225 billion on health care from private and public funds in 2009, more than 10 percent of the state's economy and the largest single sector of its economy.

The number has grown since and is likely to jump sharply once billions of additional dollars begin flowing into the state's health sector from the federal Affordable Care Act. It will provide coverage to at least half of the state's estimated 7 million medically uninsured residents, much of it coming from the federal government but some from individuals and private employers.

The Wall Street Journal said that California's per capita spending on hospitals, the biggest single chunk of health care expense, was particularly low in 2009 - $2,077 or sixth lowest among the states. Its spending on prescription drugs was also among the nation's lowest, as was its level of obesity, at 23.8 percent of the adult population.

PHOTO CREDIT: Rich Pedroncelli / Associated Press file

Middle class Californians counting on federal health-care reform to lower their insurance premiums are in for a double-digit shock next year, a new state study shows.

People or families who buy insurance for themselves could see rate increases of up to 30 percent. Milliman consulting group performed the analysis, but scope was limited to the individual market, meaning about 5 million Californians who do not receive insurance through their employer.

Millions of low-income Californians will see their costs plummet while costs rise for households where incomes exceed about $46,000 for an individual or $94,000 for a family of four, the study concluded.

Comparisons are skewed somewhat by stiffer coverage requirements for next year's plans, but the bottom line is that the poor are likely to pay significantly less than they do now while middle-class families dig deeper into pocketbooks.

"Our top priority is to provide Californians with affordable health insurance options, and we are pleased that most individuals will pay lower rates and receive better coverage," said Peter V. Lee, director of the state's health-care exchange, which commissioned the study.

Health care has become, by most measures, the largest single piece of the California economy, well over 10 percent of its $2 trillion output of goods and services -- and destined to grow as the state extends medical insurance coverage to millions of Californians under the federal Affordable Care Act.

Nevertheless, a new nationwide study finds that as large as it may be, the health care spending in California has been relatively small, compared to other states.

The statistical compilation by the Dallas-based National Center for Policy Analysis found that as of 2009, the latest year for which complete data were available, California was sixth lowest among the states in public and private health care spending as a proportion of its economy. The state's relative spending, 12.5 percent of its economy, was just 84 percent of the national average.

Love it or hate it, here it comes. Health-care advocates held a series of events throughout California on Thursday to celebrate the third anniversary of Congress' passage of the Affordable Care Act and to urge state officials to move quickly in preparing for its implementation in January.

"We think this is important to California's future, as transformative, as the building of the railroad or the establishment of the University of California," Anthony Wright, director of Health Access, said of Obamacare. "We need to embrace it fully and urgently."

Federal health-care reform cleared its final congressional hurdle and was sent to President Barack Obama on March 23, 2010. Hotly contested, the massive reform measure was designed to overhaul health insurance in a way that ensures that nearly all Americans purchase at least a basic level of medical coverage or pay a penalty.

Health Access, a nonprofit group supporting Obamacare, released a report Thursday that concluded millions of Californians already have benefited from consumer protections, subsidized care, business tax credits, or changes in insurance coverage sparked by the Affordable Care Act.

Citing a need for more medical professionals to be able to treat patients who will soon have health insurance under the federal Affordable Care Act, Sen. Ed Hernandez today introduced a package of bills allowing optometrists, pharmacists and nurse practitioners to expand the services they can offer patients.

The so-called "scope of practice" bills set the stage for a massive fight with the state's doctors, who will likely fight to protect their role as gatekeepers to medical care.

In a news conference at a Sacramento health clinic, Hernandez argued that because of a shortage of doctors in California, other kinds of medical professionals should be permitted to offer patients more care.

"Here in the state of California, we have a capacity issue. We have a work-force shortage," Hernandez said, adding that the problem is most severe in rural and inner-city areas.

With the federal health care overhaul kicking in, he said, nearly 5 million Californians who don't now have health insurance will be required to be insured as of next year.

"How is it that we're going to be requiring somebody to purchase health insurance, but yet they won't have access to a doctor?" Hernandez said. "This is what we need to address."

Hernandez's proposals will soon be spelled out in Senate Bills 491, 492 and 493. Sen. Fran Pavley is also working on Senate Bill 352, which would expand the scope of practice for physician's assistants.

PHOTO CREDIT: Sen. Ed Hernandez, D-West Covina, urges lawmakers to approve a Medi-Cal-related measure on Thursday, March 7, 2013. Rich Pedroncelli / Associated Press

By Cynthia Craft
ccraft@sacbee.com

Dozens of bereaved parents who lost children to opiate overdoses told state legislators Monday that the California Medical Board is failing to protect the public from "dirty doctors" who over-prescribe addictive drugs, especially to young adults.

The reports of a growing epidemic in California mirror nationwide statistics from the Centers for Disease Control and Prevention, which revealed new data recently showing the number of deaths due to pain medicine overdoses have increased for the 11th year in a row.

Testimony from California parents, each displaying a framed photograph of their lost loved one, came during a routine review of the California Medical Board in a Joint Oversight Hearing of the state Legislature. Every 10 years, the Legislature's business and professions committees in the Senate and Assembly must review the performance of the board and approve its continued existence.

The Legislature approved two bills today to expand Medi-Cal coverage to more than 1 million low-income California residents under the federal Affordable Care Act.

Assembly Bill 1x 1 now heads to the Senate, after passing the Assembly 53-22. Shortly after the Assembly vote, the Senate sent the Assembly a similar Medi-Cal expansion bill 24-7. Senate Bill 1x 1 is authored by Sen. Ed Hernandez, D-West Covina.

"Expanding health coverage to low-income adults will ensure Californians have access to care, which will help ensure a more healthy workforce and implementing the expansion will bring billions of federal dollars to the California economy," Hernandez said.

Assembly Speaker John A. Pérez, D-Los Angeles, authored AB 1x 1 and said it is an important step to ensuring people living significantly below the poverty line have access to quality care. In addition to expanding eligibility, Pérez's bill aims to streamline enrollment to reduce the time it takes to receive coverage.

Under the health care law pushed by President Barack Obama, most Americans will be required to buy health insurance by January 2014 or pay a penalty. The tab for the California Medi-Cal expansion will be picked up by the federal government for the first three years. In subsequent years, the federal government will cover 90 percent of the cost.

The perennially contentious relationship between the state and county governments over money has a new flash point -- the expansion of Medi-Cal coverage to more than a million low-income Californians under the new Affordable Care Act.

The conflict -- aired Wednesday in an Assembly budget subcommittee hearing -- has two prongs:

• Whether the state or counties will manage the expansion.
• Whether the state should "claw back" some of the money it now pays to counties to pay for indigent medical care -- on the theory that many of the half-million poor beneficiaries will become Medi-Cal patients next year, raising state costs.

Gov. Jerry Brown's administration is still undecided whether to opt for county or state management, but the larger counties have said they don't want it, the Legislature's own budget analyst recommends state management, and the major pending implementation bill also opts for state operation.

Millions of uninsured Californians will soon be required to purchase health insurance, and Wednesday morning they got a glimpse of what to expect under the state's marketplace.

Covered California, the organization responsible for implementing the federal health insurance overhaul, released a blueprint for what types of coverage will be available on the state's insurance exchange. The federal Affordable Care Act requires state exchanges to be up and running by 2014.

Peter Lee, executive director of Covered California, said the government-regulated exchange will add some much-needed standards and transparency to California's health insurance market.

"They are ready to play by the rules," Lee said of the insurance industry at a news conference at his organization's downtown Sacramento headquarters. "They are ready to embrace the opportunity to compete not based on a shell game of hidden benefits but based on quality and value."

There will be four plans available: platinum, gold, silver and bronze. The premium would cover 90 percent of the cost under the platinum plan, with copays making up the other 10 percent. Under the bronze plan, the premium would cover 60 percent, and copays would account for the other 40 percent.

California has one of the nation's lowest rates of smoking -- just 13.6 percent of adults light up -- but the American Lung Association gives the state low marks for reducing tobacco use, primarily for not taxing cigarettes more and not spending more on anti-smoking programs.

The critique of California is contained in the organization's annual state-by-state "report card" on anti-smoking efforts.

While praising the state as an early leader in persuading its residents to give up cigarettes, the association raps the state for not raising cigarette taxes higher than the current 87 cents a pack and decried voter rejection of a $1 per pack increase last year (Proposition 29). It said California is one of only three states that haven't raised smoking levies since 1999. It also singles out the Legislature for stalling action last year on Senate Bill 575, which would have removed exemptions from smoke-free places.

The Obama administration gave California's subsidized health care marketplace conditional approval today as the state prepares to sign up subscribers in October.

The marketplace, dubbed Covered California, plans to serve hundreds of thousands of uninsured residents who are eligible in 2014 for federal subsidies to obtain health coverage. Starting next year, all Americans are required to obtain insurance or pay a penalty under the 2010 federal health care overhaul.

California has received $237 million in federal grants so far to build its marketplace, which pays for a new IT system that enrolls subscribers statewide, marketing efforts and staff to operate the program. Federal officials are watching California with particular interest, given that it is the most populous state and has unique language and cultural barriers among its uninsured population.

To date, the federal government has approved so-called "health exchanges" in 19 states and Washington, D.C.

California primary care doctors expect to receive more than twice their current reimbursement rate for treating Medi-Cal patients next year, but those higher payments will now be delayed, according to state officials.

The change in reimbursement rates is part of President Barack Obama's health care overhaul. The federal government has agreed to fund primary care for Medi-Cal patients at the same rate that it pays Medicare providers, hoping to expand the number of doctors willing to treat low-income patients before the Affordable Care Act kicks into overdrive in 2014.

In California, which pays one of the lowest Medicaid rates in the country, primary care physicians can expect to receive 136 percent higher reimbursements, according to the Kaiser Family Foundation.

The state Department of Health Care Services says it intends to eventually give higher payments to doctors for treating Medi-Cal clients, including retroactive payments for treatment after Jan. 1. DHCS blamed the delay on bureaucratic reviews that are not yet final, and it suggested other states also won't be able to pay immediately.

"Since the payment increase will be retroactive to January 1, 2013, any delay in implementation is not expected to impact a provider's willingness to continue serving Medi-Cal members," said DHCS spokesman Norman Williams in a statement.

Gov. Jerry Brown has suggested in recent days that he may not embrace that expansion if it comes with higher state costs, though his argument appeared to be based on his own speculation that "fiscal cliff" negotiations may lead to a dramatic rollback in the Affordable Care Act.

The U.S. Court of Appeals for the 9th Circuit ruled today that California can cut rates to doctors, pharmacists and other providers for serving Medi-Cal patients, overturning a lower court decision that blocked a state budget cut from last year.

A three-judge appeals court panel determined that U.S. Health and Human Services Secretary Kathleen Sebelius has authority to determine whether California and other states can cut Medicaid rates -- the federal program of which Medi-Cal is part -- and still comply with the program's rules.

"The Medicaid program is a colossal undertaking, jointly funded by the federal government and the States," the 9th Circuit panel wrote. "Congress explicitly granted the Secretary authority to determine whether a State's Medicaid plan complies with federal law."

Sebelius approved California's cuts in October 2011, but U.S. District Court Judge Christina A. Snyder blocked them in December of last year. At the time, the cuts were expected to save $623 million annually.

California appealed the decision, and the 9th Circuit ruled in the state's favor today. It remains to be seen whether California will follow through with a 10 percent reduction to provider rates, and when that might occur.

Lynn S. Carman, who represents pharmacists as chief counsel for the Medicaid Defense Fund, said plaintiffs plan to ask the court for en banc review, meaning the full 9th Circuit bench would reconsider today's decision. If that is denied or the review does not block the rate cuts, Carman said his side would ask the U.S. Supreme Court to consider the case.

California, the nation's most populous state, also has the nation's largest number of medically uninsured children, but has lowered that number sharply in recent years, according to a new study by Georgetown University's Health Policy Institute.

Ironically, however, the study attributes that decline from 2009 to 2011, in part, to the state's Healthy Families program, which was repealed this year as part of the 2012-13 state budget, saving $13 million. Children who had been insured under Healthy Families are now being shifted into the Medi-Cal program, a move that has angered children's health advocates.

Georgetown's Center for Children and Families calculates that the number of medically uninsured California children dropped from 890,998 in 2009 to 744,797 in 2011 and the proportion from 9.5 percent of the state's children to 8 percent, just slightly above the national rate of 7.5 percent.

The 2011 rates ranged from a high of 16.2 percent in Nevada to a low of 1.7 percent in Massachusetts, the latter reflecting the universal health insurance program instituted by the state's former governor, Mitt Romney, now the Republican candidate for president. California's 8 percent rate was the 35th highest among the states.

An upcoming U.S. House of Representatives vote to repeal the federal health care law is fueling a new round of political ads in a heated East Sacramento County congressional race.

House Republicans announced plans for vote shortly after the U.S. Supreme Court upheld the 2010 law backed by President Barack Obama. The Wednesday vote is seen largely as a political maneuver meant to energize voters opposed to the law, as any effort to repeal the health care overhaul has no chance of passing the Democrat-controlled Senate.

But supporters of the law are also seeking to capitalize on the effort in the 7th Congressional District, where Democrat Ami Bera is challenging Rep. Dan Lungren, R-Gold River, for the second time.

The Democratic Congressional Campaign Committee launched a series of robocalls to independent voters last week, alleging that the Gold River Republican "wants to put insurance companies back in charge of our health care" by getting rid of the law. It followed up this week with a paid Web ad on YouTube highlighting provisions mandating preventative care and coverage for preexisting conditions that would be eliminated if that law is repealed.

Meanwhile, the American Action Network, a nonprofit advocacy group that does not have to disclose its donors, announced that it is sending voters in the district a mail piece urging Lungren to continue to fight for repeal. The group, which is spending $1.2 million on an "issue advocacy" campaign calling for repeal across the country, also ran an ad in Sunday's edition of The Sacramento Bee.

"The Supreme Court has upheld Obamacare. Congress has only one option: Repeal the President's government takeover of your healthcare," read both pieces, which contend the law will lead to new taxes and cuts to Medicare.

The Brown administration said today that it is rapidly moving ahead on California's health care expansion following the U.S. Supreme Court ruling upholding President Barack Obama's signature law.

"This is a very great day," state Health and Human Services Secretary Diana Dooley said. "California has been a leader in health care reform for a very long time. We've had many starts and stops, and we are now in the full go mode here."

At stake for California was billions of dollars in federal aid for the state's expansion of coverage.

Under the Affordable Care Act, the state is expected to receive $45 billion to $55 billion from the federal government from 2014 to 2019 to expand Medi-Cal, California's version of Medicaid. An additional 1.2 million to 1.6 million Californians are expected to be newly covered under the program.

In addition, through the California Health Benefit Exchange, a public health insurance marketplace prescribed by the federal overhaul, officials estimate about 2 million Californians -- many of them currently uninsured -- will obtain insurance beginning in 2014.

"This ruling removes a distraction from the job that thousands of Californians have come together to address," said Peter Lee, the exchange's executive director.

Lee said the state is "moving full-speed ahead" to establish the exchange, including a "major media and outreach campaign" next year.

"We look forward to making the purchase of insurance through California's exchange as easy as buying a book on Amazon or shoes on Zappos," Lee said.

Gov. Jerry Brown was among state Democrats celebrating the ruling. He said in a prepared statement, "Today's dramatic Supreme Court ruling removes the last roadblock to fulfilling President Obama's historic plan to bring health care to millions of uninsured citizens."

Today's U.S. Supreme Court decision upholding a key part of the federal health care law has sparked strong reactions from both sides of the debate.

A collection of statements and responses from California officials and groups is posted after the jump. You can send your statement to hmadans@sacbee.com. Read more coverage of the decision at SacBee.com.

There's still one potential November ballot measure pending - one that would subject health insurance rates to state regulation - and with only hours before the qualification deadline, its fate is up in the air.

Santa Monica-based Consumer Watchdog, a veteran of several high-profile ballot measure battles, and sponsored the initiative measure after the Legislature blocked a rate regulation bill that Insurance Commissioner Dave Jones had sought.

Consumer Watchdog submitted more than 800,000 signatures in May, and midnight Thursday is the deadline for counties to report whether validation sampling indicates that a full count would generate the 504,760 registered voter signatures needed to qualify. If it doesn't make it, the measure will proceed to a full signature validation count, but even if successful would not appear on the ballot until 2014.

To date, validation is running just under 70 percent and it would have to maintain that level, assuming all counties complete their processing, to make it to the ballot this year.

It all hinges on Los Angeles County, which has yet to submit any validation data. "It's going to be close," Jamie Court, Consumer Watchdog's president, said Wednesday.

If the measure qualifies, it will spark a multi-million-dollar shootout pitting Court's organization and its allies, including labor unions, against the huge health care insurance industry, medical care providers and business groups.

Twelve measures have already qualified for the ballot, including two high-profile tax increase measures, but the Legislature may remove an $11 billion water bond it had placed before voters.

U.S. Surgeon General Regina Benjamin was in Sacramento on Wednesday to talk up wellness.

About 70 California health advocates and others were on hand at the California Museum as Benjamin unveiled the National Prevention Council's new action plan aimed at helping all Americans stay healthy at all stages of life.

"Health does not occur in the doctor's office or hospitals alone," Benjamin told them. "It also occurs where we work, where we learn, where we play."

All 17 federal departments and agencies on the council will be combining efforts for the first time to reach goals such as increasing tobacco-free environments as well as access to healthy, affordable foods. Benjamin also pointed to the Environmental Protection Agency's work on enforcing the Clear Air Act and preventing asthma.

The plan, which complements efforts already under way, is meant to tackle obesity, tobacco use, health disparities among population groups, chronic disease and other issues. It stresses empowering people themselves, encouraging healthy and safe community environments, increasing preventive services and eliminating health disparities among population groups.

Some examples include businesses running carpool programs to cut air pollution, communities setting up diabetes prevention programs, health care professionals using social media to encourage healthy living, and health care providers hiring more qualified staff from minority groups.

After Benjamin spoke, panelists discussed the importance of getting healthy lunches in schools and eliminating health disparities so people of color are not more likely to be obese or have chronic conditions than the population as a whole.

Others stressed the importance of youth in any health movement.

"We see young people not as a problem," said Olis Simmons, the founder of the Oakland's Youth UpRising. "We see young people as our partners in changing the community."

A little under a thousand people gathered at the Capitol Thursday to deliver 75,000 petitions and ask legislators to reject cuts to the in-home care system.

Gov. Jerry Brown's proposed budget cuts include a 7-percent cut to caregiver hours and the elimination of domestic services in shared households, adding up to a $224.5 million reduction.

Doug Moore, executive director of the UDW Homecare Providers Union, said he came to the rally because he was "preparing for attack on the budget proposal by the governor."

He said IHSS saves the state money. Putting someone in an institution can cost around $5,000 a month, he said, while caring for them at home costs $800 a month.

"I'm sick and tired of having to be here every year, but I'm not too sick and tired to not fight back," Moore said.

Republican U.S. Senate candidate Elizabeth Emken this week defended her work lobbying to include autism coverage in the federal health care overhaul backed by President Barack Obama in 2009, even though she opposed the bill.

Emken, one of 23 candidates challenging Democratic U.S. Sen. Dianne Feinstein on the June 5 ballot, has come under fire from Republican opponents over records showing Autism Speaks sought to influence the outcome of the legislation when she was listed as a top lobbyist for the nonprofit advocacy group.

The Danville Republican, whose 19-year-old son is autistic, said the organization lobbied lawmakers to include language to ensure that health care companies would provide coverage for medical issues and treatment related to the condition under the new law.

Emken said that while she disagrees with the overall approach of the health care overhaul, the effort to include the language was important for her and the organization because autism is "perfect example of a catastrophic medical event" that some insurance companies will not cover.

"What we were doing is, as everyone was doing when you have a Democratically-controlled Senate, House and president, everyone, Democrats and Republicans are all working on a piece of legislation that's on the table," she said during a Sacramento press availability Tuesday. "That's how it's done. You don't just walk away if you don't like how things are going. You continue to work on it."

Emken said the reference to autism did not make it into the bill, which was signed into law in 2010, and regulatory language emerging on the issue is "extremely nebulous." She said that outcome reinforced her opposition to the law.

"The issues are so long and vast and broad with Obamacare," she said, "I really believe the only solution is to repeal it, but I do believe in replacing it with real health care reform and real health insurance reform."

Emken dismissed the attacks from opponents, saying they are "to be expected" because she won the endorsement of the California Republican Party.

"As you can imagine, it's very natural that I'm sure the other Democratic candidates are going to be making comments about Dianne Feinstein and (Republicans are) going to be making comments about me and they're going to be unified in that because I have the support of the California Republican Party," she said.

PHOTO CREDIT: Republican candidate for U.S. Senate, Elizabeth Emken speaks at a news conference in Sacramento on April 10, 2012. Associated Press/Rich Pedroncelli

A tentative winner has been announced for a $900,000 public relations contract to help California implement federal health care reform: Sacramento's Ogilvy Public Relations Worldwide .

Ogilvy was chosen this week by the California Health Benefit Exchange to create a statewide marketing, outreach and education strategy designed to help reduce the number of Californians lacking health insurance.

The state exchange is charged with creating a new insurance marketplace for individuals and small business to buy competitively priced health plans beginning in 2014.

Ogilvy's selection is tentative pending a five-day protest period, ending March 7.

The contract is considered a plum of California state public relations contracts partly because the winner of the initial $900,000 pact, through October 2013, will be in key position to obtain a subsequent contract that could total tens of millions of dollars to launch the exchange.

The PR powerhouse made headlines earlier this year for quitting a $9 million contract with the state's high-speed rail authority.

In a letter to rail officials, Ogilvy said that it was "unable to develop a solid working relationship with your agency, and that impeded the kind of top-notch work we are accustomed to providing our clients."

The most contentious bill in the 2011 legislative session's final days would subject the multibillion-dollar health insurance industry to state rate regulation -- and it's spawned a boatload of campaign contributions, according to a new compilation.

Assembly Bill 52 is now pending on the Senate floor after clearing the Assembly on a 45-28 party-line vote, with Democrats in favor and Republicans opposed. Carried by Assemblyman Mike Feuer, D-Los Angeles, and sponsored by Insurance Commissioner Dave Jones, the measure also enjoys support from consumer activists, labor unions and other Democrat-friendly groups, while it's opposed by the health insurance industry and business groups.

Maplight, an organization that tracks campaign contributions and ties them to specific issues, says in its report that advocates of the measure have contributed nearly three times as much money to state senators as its opponents.

The Senate outcome is uncertain, even though Democrats could pass it without Republican votes, because it's also drawn opposition from local governments, pension funds and Gov. Jerry Brown's administration, the latter citing costs of implementation.

Advocates say that the measure would protect health care consumers from being gouged, especially in light of the federal government's new mandatory coverage law.

Maplight says that advocates of the measure have contributed $1.3 million in the last three years to senators who will be voting for or against the bill while opponents have given $455,000. The contrast was especially evident among senators who voted on the bill in the Senate Appropriations Committee last week, Maplight said.

It should be noted, however, that the groups weighing in on AB 52 typically have other issues pending before the Legislature, and the pro-AB 52 groups historically support Democrats, while those opposed are more likely to support Republicans.

The full Maplight report can be found here.

The state's new health benefit marketplace, an instrumental arm of the 2010 federal health care overhaul, will announce today that it has tapped an Obama administration official as its first executive director.

Peter V. Lee, deputy director for the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services, will assume the California Health Benefit Exchange job on Oct. 17, 2011.

He will receive a salary of $250,000, more than the $173,987 that Gov. Jerry Brown receives.

Lee previously served from 2000 to 2008 as executive director and CEO of the Pacific Business Group on Health, a San Francisco-based nonprofit that seeks to leverage employer health care purchasing power. That role is similar to one that the exchange is expected to play on behalf of individuals and small businesses.

The California Health Benefit Exchange announced earlier this month that it had received a $39 million federal grant to lay groundwork over the next year. Under the 2010 federal health care law, state exchanges will negotiate with health plans to provide subsidized benefits to low- and middle-income individuals, as well as small businesses. The California program is expected to begin enrolling Californians in late 2013, with benefits starting in 2014.

The law is subject to legal challenge, principally over whether it is constitutional for the federal government to require individuals to carry health insurance. The U.S. Supreme Court is expected to eventually decide the matter.

The state Supreme Court handed insurers and business groups a major legal victory -- and personal injury lawyers an equally big setback -- on Thursday by imposing limits on medical damages in one of the era's closest watched civil cases.

The issue in the case, Howell v. Hamilton Meats & Provisions, was whether an injured party could collect the full medical care costs billed by doctors and hospitals, or the lesser amount that the medical providers accepted from an insurance company.

As the 6-1 decision put it:

"In that circumstance, may the injured person recover from the tortfeasor, as economic damages for past medical expenses, the undiscounted sum stated in the provider's bill but never paid by or on behalf of the injured person? We hold no such recovery is allowed, for the simple reason that the injured plaintiff did not suffer any economic loss in that amount."

Insurers had said that if they had lost the case, it would add as much as $3 billion a year to their payouts in auto accidents and other personal injury cases. Plaintiffs' attorneys would have been entitled to about a third of that amount.

The case stemmed from a San Diego County collision in which Rebecca Howell was injured by a truck, driven by an employee of Hamilton Meats, which was making an illegal u-turn. Her medical bills totaled $190,000 but her health insurer settled the bills for $59,691 and the question was whether she would receive the full $190,000 from Hamilton's insurer.

Hamilton won at the trial level but lost at the appellate level. The case went to the state Supreme Court along with several other appellate decisions on the same issue, one of which was authored by Chief Justice Tani Cantil-Sakauye before her elevation last year to the Supreme Court.

However, Cantil-Sakauye in effect reversed herself by voting with five other justices that the payout should be limited to $59,691.

Joan Klein, an appellate court justice sitting on the Supreme Court for the Howell case, was the lone dissenter in Thursday's ruling. She agreed that the $190,000 was too much, but said the trial court should be empowered to decide what the proper amount should be.

California's new state marketplace for health insurance announced Friday that it has received a $39 million federal grant to launch major operations over the next year.

The California Health Benefit Exchange is part of the federal health care overhaul approved last year. Starting in 2014, the exchange is expected to provide new health insurance options to individuals and small businesses after negotiating rates with health plans.

Such rates are supposed to be more affordable for employers and individuals because the state would leverage its negotiating power for more than 1.5 million enrollees, while the federal government would provide subsidies and tax credits. But the five-member exchange board still has to sort out many questions, such as whether to focus more on price or quality of care, as well as how best to enroll individuals across a wide range of income levels.

The health exchange intends to use the grant toward its three-year business plan, as well as to hire a contractor to build its information technology platform.

California was the first state last year to establish a state health exchange. As part of a deal struck with the Legislature, former Gov. Arnold Schwarzenegger received two four-year appointments to the board not subject to legislative approval. He appointed Susan Kennedy, his chief of staff, and Kimberly Belshé, his Cabinet secretary for health and human services, in the final days of his tenure.

Other appointees include: Robert K. Ross, president and CEO of The California Endowment (appointed by Senate President Pro Tem Darrell Steinberg); Paul Fearer, a Union Bank executive and board chairman of the Pacific Business Group on Health (appointed by Speaker John A. Pérez); and Health and Human Services Secretary Diana Dooley, who serves as board chairperson.

The Assembly passed one of the year's most controversial and intensively lobbied bills Thursday -- imposing rate regulation on health insurers -- after Republicans walked out of the chamber in protest.

GOP members wanted to call a caucus to discuss the measure, Assembly Bill 52 by Assemblyman Mike Feuer, D-Los Angeles, but Speaker John A. Perez refused to call a recess. Democrats then defeated a recess motion with leaders saying Republicans were trying to stall long enough to kill the bill because of Friday's deadline for action.

The GOP retreated to the Rules Committee room off the chamber and closed the door.

Without Republicans on the floor, the remaining Democrats conducted a brief debate, with Feuer arguing that regulation by the insurance commissioner is needed because "health insurance rates are skyrocketing." Several Democrats were critical of the bill but just one, Sacramento's Richard Pan, voted against it as the measure was sent to the Senate on a 42-1 vote. Pan is a physician.

Health access groups and Insurance Commissioner Dave Jones, whose presence on the floor prior to the bill debate had irked Republicans, have lobbied for the bill while health insurers, backed by business groups, oppose it.

Republicans, meanwhile, ended their off-the-floor meeting about 30 minutes later, but were clearly still peeved about what they called unprecedented and disrespectful actions by their Democratic colleagues.

"I think you just saw the budget explode," said Assemblyman Kevin Jeffries, R-Lake Elsinore. "Over the stupidest reasons the Speaker has decided apparently to disrespect the Republican leader and the Republican caucus and I think there's going to be significant consequences for that."

Democrats shot back by pointing out that their colleagues returned shortly before Green Bay Packers quarterback Aaron Rodgers paid a visit to the floor to be honored by Assemblyman Dan Logue, R-Linda.

"The Republicans walked out on their job and on the consumers of California, but managed to come back to work 30 minutes later when it was time to get autographs from a famous football player," said Perez spokeswoman Robin Swanson.

Friends and foes of the federal health care overhaul are marking today's one-year anniversary of President Barack Obama signing the Patient Protection and Affordable Care Act into law.

Supporters of the federal health care law have planned events across the state to celebrate the law's first birthday. Lt. Gov. Gavin Newsom will be in Los Angeles this afternoon to tout the positive impacts that supporters say the changes are having on Californians, while Democratic Rep. Doris Matsui, Insurance Commissioner Dave Jones and Democratic Assemblyman Richard Pan, a pediatrician, are all scheduled to attend events in the Sacramento region.

"In just one year, hundreds of thousands of Californians have directly benefited from the passage of the Affordable Care Act," Anthony Wright, executive director of Health Access California said in a statement. "The law is making a difference, from the tens of thousands of young adults and those with pre-existing conditions taking advantage of new options for coverage, to the hundreds of thousands of seniors and small businesses getting direct help to afford coverage."

Meanwhile, opponents of the plan are marking the anniversary by pointing out shortcomings and renewing pledges to fight the law.

GOP Rep. Jeff Denham of Atwater issued a statement vowing to "continue to dismantle ObamaCare through more votes and hearings in the House in order to replace it with affordable solutions and common-sense reforms that protect jobs."

"The health care law forced through Congress by the Democrats and the President one year ago has completely failed to live up to the promises it made to the American people," Denham said in a statement blasting the law for increasing costs.

California Republican Party Chairman Tom Del Beccaro pointed to polls showing opposition to the law and cases in which federal judges deemed at least part of the plan unconstitutional.

"The 63 Democrats who lost their seats in November are the people who should be organizing a wake," Del Beccaro said in a statement. "Polls are now showing that most Americans want Obamacare repealed, 28 states are challenging the law in court, two federal courts have said it's unconstitutional, and the 1000+ waivers prove that this law has not achieved what it set out to do and is in fact a job-killer. If this keeps up, Obamacare's first anniversary might just be its last."

PHOTO CREDIT: President Barack Obama, surrounded by lawmakers and guests, signs the health care insurance reform legislation during a ceremony in the East Room of the White House in Washington on March 23, 2010. Saul Loeb/ AFP.

California's "well-being index" is just about average in a new nationwide survey measuring levels of healthy and happy living by the Gallup polling organization - but residents of the San Francisco Peninsula score the highest of any region in the nation.

It was the third year in a row that residents of California's affluent and bucolic 14th Congressional District scored the highest in the survey, which measured levels of diabetes, obesity, consumption of fresh produce, physical exercise, optimism and health insurance coverage.

Gallup surveyed more than 350,000 people nationwide to create its index and rankings by state and locality. The 14th Congressional District includes Redwood City, Palo Alto, Menlo Park, Mountain View and Los Altos and is represented by Democrat Anna Eshoo.

The nation's overall well-being index is 66.8 while California's score - 18th highest - is 67. Hawaii scored the highest at 71 while West Virginia is the lowest at 61.7. The full Gallup report can be found here.

Rep. Dan Lungren couldn't be blamed if his chest puffed up with pride just a little when President Barack Obama gave a shout-out to a bill of his during the State of the Union last week.

The measure -- which would repeal a provision of the health care reform law that has nothing to do with health care -- drew not a ton of attention or support when Lungren first introduced it last year.

Now, it is on the front burner of the new Republican leadership in the House (given the priority designation of House Resolution 4) and it has some 260 co-sponsors, including many Democrats. It appears likely that it will be the one part of the health care law that will be repealed.

Lungren told The Bee's editorial board this afternoon that he was "surprised, but pleased" that the president gave it a thumbs up during his speech.

From the Associated Press:

PENSACOLA, Fla. - A federal judge in Florida says the Obama administration's health
overhaul is unconstitutional, siding with 26 states that had sued to block it.

U.S. District Judge Roger Vinson on Monday accepted without trial the states' argument
that the new law violates people's rights by forcing them to buy health insurance by 2014 or face penalties.

Attorneys for the administration had argued that the states did not have standing to
challenge the law and that the case should be dismissed.

The case is likely to go to the U.S. Supreme Court. Two other federal judges have
upheld the insurance requirement, but a federal judge in Virginia also ruled the insurance requirement unconstitutional.

Here is the link to the AP story that will be updated.

Vinson's ruling has already garnered attention for his conclusion that "Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void."

POLITICO has posted the full decision at this link.

The American Lung Association praises California for its laws barring smoking in public places, but otherwise gives the state low marks in its annual state-by-state survey of anti-smoking efforts.

California - like all but a few other states - was given an "F" for its spending on anti-smoking campaigns. The Centers for Disease Control says California should be spending nearly $442 million a year, but it spends only $89.7 million, all of which comes from cigarette taxes and federal allocations.

It also gets a "D" for its relatively low level of cigarette taxes, 87 cents a pack, and another "F" for its laws and regulations compelling health insurers to cover smoking cessation treatment. Nationwide, cigarette taxes range from $4.35 a pack in New York to 17 cents in Missouri.

The lung association is one of the sponsors of a ballot measure -- which could face voters as early as June -- that would would raise the tobacco tax by $1 a pack to fund cancer research and smoking prevention programs.

Overall, the ALA says, California has 235 annual deaths per 100,000 population attributed to smoking, roughly in the middle of the states. The lowest rate of smoking deaths is in Utah, 138.3, and the highest is in adjacent Nevada, 343.7.

The full Lung Association report may be found here.

PHOTO CREDIT:Carmen Werle smokes a cigarette on her lunch break outside the Department of Justice in Sacramento on Wednesday, June 23, 2010. Kyle Grantham/Sacramento Bee.

As recession continues to grip the state, the number of Californians without health insurance, especially coverage provided by employers, has continued to climb, according to a new study by the California Healthcare Foundation.

Over the last two decades, the foundation says, Californians under 65 with employer-provided health insurance have dropped from 65 percent to 52 percent and "while increases in Medicaid (Medi-Cal) coverage partially offset this decline, more than 20 percent of Californians remained uninsured."

The state has the nation's highest number of uninsured, 6.8 million and one of its highest rates. The foundation, in its annual California Health Care Almanac, says 60 percent of Californians without health coverage are Latinos, and more than half of uninsured children are in families headed by full-time workers.

The complete report is available here.

California's supply of physicians has been growing faster than its population in recent years and now matches the national ratio. While specialists abound, however, primary care physicians are in relatively short supply and the squeeze could increase as older doctors retire and demand for care increases under the new federal health plan.

So concludes a statistical report by the California Healthcare Foundation. "With large numbers of physicians nearing retirement," the foundation says, "and not all doctors taking patients with private or public insurance, those seeking care, especially in some regions, could have difficulty finding a provider."

Nearly 30 percent of California's physicians are 60 years or older, a higher percentage than any other state, the study found, and the state is increasingly dependent on foreign-trained physicians.

The full report can be found here.

PHOTO CREDIT: Dr. Nathan Hitzeman, a primary care physician, discusses a patient's symptoms with third-year resident Laura Applebaum at Sutter's Alhambra Family Practice on May 20, 2010. Sacramento Bee / Manny Crisostomo

Los Angeles County has one of the nation's lowest rates of smoking. But after years of sharp decline, the rate has remained static for the past eight years, according to a new study by the county's health department.

L.A. County's 10-plus million residents are more than a quarter of the state's population and the new study says 14 percent of its non-children - more than a million persons - are smoking, including 12 percent of teenagers.

The county's smoking rate is virtually identical to California's statewide rate, which is the second lowest of any state. Utah is by far the lowest at less than 10 percent, while Kentucky, a tobacco-growing state, is highest at 28-plus percent. California has spent tens of millions of dollars, much of it raised from cigarette taxes, to persuade Californians to quit smoking.

The Los Angeles study found wide disparities in smoking rates among the county's geographic areas and ethnic groups.

Wealthy, mostly white and Asian-American San Marino had the county's lowest rate of smoking, 5.3 percent, while in Quartz Hill, due north of San Marino on the other side of the San Gabriel Mountains, it was 21.9 percent.

L.A.'s men are more likely to smoke (19 percent) than women (10 percent) and black Angelenos, at 25 percent, are heavier smokers than whites (15 percent), Latinos (12 percent) or Asian Americans (11 percent).

"Targeted efforts are needed to further reduce cigarette smoking, especially among high-risk groups," the county's public health director, Dr. Jonathon Fielding, said in a cover letter.

The full report is available here.

With one day left until the deadline for bills to pass out of the house of origin, expect a lot more action coming from both chambers.

The Senate has about 30 bills left to take up. Two Democratic members who have been absent due to medical conditions, Jenny Oropeza, who suffered from a blood clot, and Pat Wiggins, who has been unable to attend sessions because of an undisclosed medical condition, will be back on the floor to cast votes for the close calls.

And as usual, both houses are leaving some of the most controversial measures for last.

Chatting on cell phones (and texting third house friends) might be banned on the floor for lawmakers, but that won't stop senators from talking about laws affecting mobile users today.

As many as two million more low- and moderate-income Californians could become eligible for health care under the state's Medi-Cal program when the new federal health care program kicks in, the Legislature's budget analyst says.

Legislative Analyst Mac Taylor's office, in an analysis of the health care program, says that expanding Medi-Cal, which now serves 7.3 million persons, would be partially financed by federal funds but still drive up costs borne by California taxpayers.

How much that will cost is still uncertain, the LAO report says, but it "will put significant fiscal pressure on the state in the out-years, particularly as the enhanced federal funding is somewhat reduced."

Gov. Arnold Schwarzenegger was a sharp critic of the federal health care program when it was being written by President Barack Obama and a Democratic Congress, citing the potentially heavy impact on a state budget that's already gushing red ink. But after enactment, Schwarzenegger pledged to fully implement it in California.

The full LAO report on the program's impact on California is available here.

By Rob Hotakainen, Washington

The ink is barely dry on the massive health-care overhaul signed into law by President Barack Obama last month, but Republican Rep. Dan Lungren is ready to do a little tinkering.

Lungren, of Gold River, introduced the Small Business Paperwork Mandate Elimination Act, which would scrap some reporting requirements contained in the legislation.

Under the new law, any business that purchases more than $600 of goods or services from another business must submit a 1099 tax form to the Internal Revenue Service. Lungren is proposing to remove that mandate, which is scheduled to take effect in 2012.

The 1099 is the IRS from the annual reporting of dividend and interest payments made to investors.

Lungren said large corporations have the personnel to handle such paperwork but that the requirement would hurt small businesses, serving as "yet another brick on their back."

"I am dumbfounded that this administration is doing all it can to make it more difficult for businesses to succeed rather than doing all it can to help them grow," Lungren said.

The White House did not respond to a request for comment.

A new statewide survey of California voters suggests that many are woefully unprepared for the costs of long-term care they may need in old age.

California could see a 27 percent increase in those receiving medical care under Medi-Cal, the federal-state program that serves low-income residents, under a major provision of the newly adopted overhaul of national health care, a new study has found.

But UnitedHealth Group also says that California could offset the higher costs and much more by upgrading its medical care delivery system. In fact, it could save 10 times as much as those extra costs, the Minneapolis-based managed care firm says.

As the largest state, California is expected to see the largest numerical growth in Medi-Cal enrollment, some 2 million, over the next nine years. But the 27 percent growth is actually below the national average of 32 percent, largely because California has a relatively large recipient base already, due to its relatively low threshold of qualifying for benefits. The program is called Medicaid in most states.

Both GOP gubernatorial candidates have joined California Republicans supporting a legal smackdown of the sweeping health care overhaul signed into law today.

Insurance Commissioner Steve Poizner launched the first strike yesterday, calling on Attorney General (and would-be rival) Jerry Brown to join the group of mostly Republican state attorneys general suing the federal government to repeal the bill.

"California is going to have an even harder time balancing the budget because of the new mandates placed upon us by the federal health care bill," Poizner said in a statement. "(More than 12) states have announced plans to challenge the constitutionality of Obamacare and given California's economic crisis, we cannot afford to let the federal government stick our state with billions more in unfunded mandates."

Whitman, too, opposes the legislation and supports the court challenges (as do all three Republicans running for U.S. Senate).

The ink has barely dried on the sweeping health care legislation signed into law today, but California Republican lawmakers have joined a chorus of critics calling for swift action to knock down the bill's big changes to the country's health care system.

"I think that many Californians share the same view that ... this is the greatest expansion of government in a generation and it is also the greatest intrusion into personal liberty and states rights that we have seen in many generations," Senate GOP leader Dennis Hollingsworth said at a press conference.

Arguing that Congress has violated the "Commerce Clause" of the Constitution by mandating that citizens obtain health coverage, the lawmakers urged Attorney General Jerry Brown to join more than a dozen attorneys general nationwide who have said they will sue the federal government challenging the constitutionality of the bill.

"The bill assumes that congressional power over the states, their citizens, and their consumers' everyday economic decision is vast and limitless -- a position that is constitutionally untenable, completely unprecedented and contradictory to fundamental principles of federalism and limited government," GOP Sen. Tom Harman wrote in a letter to Brown.

More than a third of California's adults and a nearly a sixth of its children suffer from chronic health conditions such as asthma, diabetes, high blood pressure, congestive heart failure or psychological distress, according to a new report from the California Healthcare Foundation.

The lengthy report, prepared by researchers at UCLA's Center for Health Policy Research, follows on another recent study indicating that California's ranks of the medically uninsured have grown sharply to more than 8 million persons. And both were issued as Congress considers President Barack Obama's historic overhaul of health coverage.

California's severe economic recession has sharply expanded the ranks of its medically uninsured residents, a new statistical study by UCLA's Center for Health Policy Research has found.

The study, based on enrollee data from private and public medical care programs, found that the uninsured under age 65 increased from 6.4 million in 2007 to 8.2 million last year, largely because of higher unemployment and cutbacks in employer-underwritten coverage. That's nearly a quarter of the under-65 population of the state.

"These estimates help us understand the scale of the damage inflicted on California over the last two years," Shana Alex Lavarreda, a co-author of the study, said in a statement. California has one of the nation's highest uninsured rates - a factor attributed to its seasonal and diverse economy - and because of its size has more uninsured residents than any other state

The study was released as Congress wrests with President Barack Obama's effort to expand coverage for the uninsured. California Gov. Arnold Schwarzenegger attempted several years ago to win legislative approval of a similar expansion of health coverage, but his measure died in the state Senate after approval by the Assembly. It was opposed by conservatives who disliked more government expansion and liberals who wanted a single-payer, government-operated program.

The full study may be found here.

By Rob Hotakainen in Washington:

While Republican leaders in Washington are urging President Barack Obama to start from scratch on a health-care bill, California Gov. Arnold Schwarzenegger on Monday dismissed the idea as "bogus talk."

It marked the second day in a row that Schwarzenegger strayed from his party's positions.

On Sunday, he defended Obama's economic stimulus plan and chided elected officials, most of them Republicans, who oppose the overall stimulus but are quick to trumpet individual projects in their states that are paid for the stimulus.

Standing outside the White House after meeting privately with Obama on Monday, Schwarzenegger touted the economic stimulus plan yet again.

"I think the stimulus package has been very successful so far and I think California has benefitted tremendously," he said.

Former Bee columnist and blogger Dan Weintraub's new health policy-focused nonprofit news Web site launched today.

Weintraub, who left the Bee for the venture in October, wrote in an editor's note that the mission of www.HealthyCal.org is "to inform Californians about public health and community health issues, to engage readers in an ongoing conversation about matters ranging from health care policy to land-use, transportation, environment, criminal justice and economic policy, and to show how all of these things are connected."

Hat tip: LAObserved

The Department of Health Care Services said today it may have breached the privacy of 49,352 state residents who receive adult day health care services from the state.

In a terse news release, the department said that letters it mailed a week ago to 49,352 beneficiaries wrongly included those patients' Social Security Number on address labels.

The Department said the incident took place Feb. 1. It was notified of the error on Feb. 4. It started to notify the 49,352 beneficiaries about the problem on Sunday.

"At this point, there is no evidence that unauthorized parties have acquired or accessed beneficiary personal information," the department said in a prepared statement. Officials said they regretted the incident.

On Saturday 6, the department said it began sending notification letters to beneficiaries alerting them to the security breach. The letter also advised beneficiaries how to protect themselves from identity theft by contacting the three credit reporting agencies and placing a fraud alert on their files.

Gov. Arnold Schwarzenegger suggested one more "trigger" alternative Monday if the federal government does not provide California with additional federal funds -- transferring undocumented immigrant prisoners to the federal government.

The Republican governor last week relied on getting $880 million in federal funds for undocumented inmates to help bridge the state's $19.9 billion deficit through June 2011. President Barack Obama proposed eliminating that funding altogether last year, and Congress plans to allocate not even half that amount for all 50 states.

"Why should we pay for it when it is the federal government that is having the lax policies on the borders, and is really in charge of immigration policies?" Schwarzenegger said Monday in Torrance during a press conference to promote his job creation plan. "So why should we pay for it? We just want to hand them over all those prisoners. You take them. If you don't want to pay us, you take the prisoners."

Former eBay honcho Meg Whitman continues to lead the two other Republican candidates for governor next year and trails presumptive Democratic nominee Jerry Brown by only a few points, a new poll by the Public Policy Institute of California has found.

Whitman's 32 percent support level among Republican voters is a big lead over either former Rep. Tom Campbell at 12 percent and state Insurance Commissioner Steve Poizner at 8 percent, but the highest proportion, 44 percent, are the undecided Republicans.

While Brown, a former two-term governor who is now state attorney general, leads all three Republicans among all voters in the survey, his support remains well below 50 percent. In a theoretical matchup with Whitman, Brown leads 43 percent to 37 percent. His margins against Campbell and Poizner are considerably wider.

While all that is interesting to political junkies, however, most Californians still haven't focused on who they may want to succeed Republican Arnold Schwarzenegger next year.

"Voters have more immediate concerns than who is going to be the next governor," PPIC's president, Mark Baldassare, said in a statement analyzing the poll results. "Despite all the advertising in this early stage of the campaign, Republican primary voters are more likely to say they are undecided than to favor one of the three GOP candidates. At the same time, the Democrats' likely candidate falls short of majority support when matched up against the Republican contenders."

Whitman has spent heavily from her personal fortune on consulting advice and advertising, but has refused to debate the other two Republicans and almost never talks to California political reporters. Poizner, also a wealthy former Silicon Valley executive, has just committed $15 million more to his campaign while Campbell has scant personal or political resources.

The PPIC poll covered a wide variety of issues, finding that Californians remain very concerned about the state's recession-wracked economy (61 percent say it's the top issue facing the state), that President Barack Obama still enjoys high approval ratings (61 percent), that barely half (52 percent) support Obama's health care plans and that Schwarzenegger and the Legislature continue to have record-low approval ratings.

The full poll, including early takes on 2010 ballot measures, is accessible here.

The cost of health insurance provided by California employers has risen five times as fast as overall inflation since 2002, according to a new survey by the California HealthCare Foundation.

Health insurance premiums increased by 117.5 percent during the period, says the California Employer Health Benefits Survey, while the state's overall cost of living rate was 23.1 percent, including a 7.5 percent gain in the last year.

The survey also found that employers are shifting some of the added costs to their workers and/or shifting to less extensive coverage. This year, for instance, more than 20 percent of covered workers in small firms had deductibles of $1,000 or more, three times as many as in 2002.

Finally, the survey revealed that six percent of employers say they are "very likely" to drop coverage completely, up from 1 percent in 2008, 27 percent say they are likely to increase employees' co-insurance and co-pay burdens, and 44 percent of large employers and 20 percent of small ones say they are "very likely" to increase employees' share of insurance costs.

The full survey can be found here.

California, for the second straight year, has received a "C" grade by the March of Dimes for its premature birthrate - but that's not as bad as it sounds.

No state received an "A" grade on programs to prevent premature births. Only one, Vermont, got a "B," while the nation as a whole earned only a "D" grade.

California's premature birthrate, 10.9 percent of live births, is up slightly from 10.7 in 2008, and is still markedly lower than the national rate of 12.7 percent. The March of Dimes goal is 7.6 percent.

"While we are working diligently to fight growing rates of premature birth, our state's grade indicates that more needs to be done to give these babies a chance at a healthy start in life," said Dani Montague, director of the March of Dimes California chapter. "Nearly 58,000 babies are born too soon in California every year, and many of these births result in ongoing health problems and months of hospitalization for these tiny newborns."

Seven states improved their scores by one letter grade and two states declined. The March of Dimes recommends that states attack premature births, the leading cause of infant deaths, through such programs as reducing smoking among women of childbearing age and improving access to prenatal medical care.

An interactive map of the United States is available here while the detailed report on California can be found here.

Rex Babin is the political cartoonist for The Bee. You can see a collection of his work here.

California expanded health insurance for children earlier in this decade, reducing the uninsured ranks by 12 percent, but additional progress has been stalled by the state's chronic budget deficit, according to a new statistical report by the California Healthcare Foundation, and coverage declined in 2008.

Reductions in Healthy Families and other programs aimed at working poor families lacking health insurance has been a major issue as Gov. Arnold Schwarzenegger and legislators deal with its ongoing fiscal crisis.

Just last month, Schwarzenegger signed an emergency bill under which hospitals agreed to pay
$2 billion in fees to the state to qualify California for $2.3 billion in new matching money to hospitals and boost funding for children's insurance by $320 million and public hospital financing by another $310 million.

The Healthcare Foundation report says that expanding children's coverage dropped the state's uninsured rate to just above the national average of 11 percent, even though 80 percent of California's children are eligible for public programs.

It also notes that California's proportion of uninsured school children, 32 percent, is also slightly above the national average, and that as private employers cut back on employees' insurance, more children are being shifted to public programs.

The full report is available here.

Gov. Arnold Schwarzenegger wrote in a letter to Congressional leaders today that while he still supports passing a sweeping overhaul of the nation's health care system, he's worried about the cost the implementation of the plan could have on California.

As Rob Hotakainen reports from Washington, one of the governor's central concerns is a proposed Medicaid expansion.

Sounding more like a Democrat than a Republican, the governor said Congress should pass a plan "quickly, thoughtfully and, most important, successfully." And he said health care should not be a partisan issue, as it has become in Washington. ...

But unless Congress pays for all of its costs, Schwarzenegger said a mandatory expansion of Medicaid "will only be an empty promise of health insurance coverage" and will force California and other states to make cuts in education, public safety and elsewhere.

Read the full text of the letter after the jump.

The sharp spike in California's unemployment rate - it's now over 12 percent of the labor force - means an equally sharp spike in the number of Californians who have lost their health insurance, a new report by Families USA, a Washington-based advocate for universal health care, concludes.

Families USA's report, issued today, estimates that California's medically uninsured population, one of the nation's highest, jumped by 661,600 persons this year to more than 6 million - by far the largest numerical increase of any state and one of the highest proportionate increases.

The state-by-state report is available here.

From Rob Hotakainen in Washington

Democratic Rep. Mike Honda of California took offense last week when Republican Minority Leader John Boehner of Ohio compared the public insurance option to a "garlic milkshake," Roll Call reports today.

Honda supports both the public option and garlic. His district includes the city of Gilroy, which hosts a garlic festival each year.

On Friday, Honda delivered a basket of garlic to Boehner's office. The minority leader's staff accepted the gift.

Boehner spokesman Michael Steel told Roll Call that the office was thankful.

"We like garlic," Steel said. "The point Boehner made was simply that garlic milkshakes aren't popular, like the Democrats' government takeover of health care."

GOP gubernatorial hopeful Tom Campbell released a unique health care proposal Thursday that would redistribute $42 billion in federal and state funds already spent on health care in California to buy private health coverage for everyone in the state who's "involuntarily" uninsured.

Under the former congressman's plan, the funds would cover an estimated 2 million such people in addition to the 7.6 million already receiving public health coverage under the state Medi-Cal and Healthy Families programs.

"The astounding conclusion," Campbell writes in his proposal, "is that, using only the money already being spent by the federal and state governments for health care in California, we could buy free market health insurance currently available and cover all involuntarily uninsured in California, and still have more than $700 per person left over!"

Campbell suggested the state launch its own plan "in the event that the federal effort does not produce meaningful reform."

His plan would let private insurers bid against each other for a fixed pot of money to cover everyone in a "relevant geographic region" who earned below a certain amount or who had been denied coverage by two private insurers because of a pre-existing medical condition.

To implement the plan, however, the state would have to win a federal waiver allowing it to use federal funds in such a way, and the federal government would have to repeal the antitrust exemption for insurance companies and also pass laws allowing the interstate sale of insurance plans.

And if no insurer bids in a region, the status quo continues.

California has one of the nation's highest proportion of residents without medical insurance, about 20 percent, but many of those with insurance have found themselves with debts from medical care, according to a new study by UCLA's Center for Health Policy Research.

More than 2.2 million adults Californians report medical debt, with two-thirds of them incurring debt while insured, according to "The State of Health Insurance in California." Overall, 13 percent of Californians have some kind of medical debt and about a third of those have more than $2,000 in medical debt.

Not surprisingly, residents of relatively low-income rural areas have the greatest levels of medical debt, as high as 39 percent in Humboldt County, while those in affluent urban areas have few such problems, just 7.1 percent in San Mateo County.

"That even insured people are forced to take on medical debt to pay for their health care is another glaring inadequacy in our current system of health insurance," said E. Richard Brown, director of the UCLA center. "Current policies either do not offer enough coverage or offer full-coverage at a cost that is too expensive for many people to bear. The result is that too many people have health insurance plans that leave them financially vulnerable and force them to delay the care they need."

The full report on Californians' health insurance, or lack thereof, is available here.

Children's health care advocates got both a boost and a blow today, as the California First 5 Commission announced it would contribute $81.4 million to the state's Healthy Families health insurance program.

But members of the Managed Risk Medical Insurance Board, which runs Healthy Families, still had to tell the program's administrators to begin disenrolling children Oct. 1 to help close a funding shortfall.

"It was a day of very good news and very bad news for kids," said Wendy Lazarus, founder of Children's Partnership, a nonprofit child advocacy organization. "I think the First 5 contribution shows tremendous leadership."

"(But) this is a really dark, grim situation for kids in California," Lazarus said. "I don't think anyone living here ever thought we would see a day where kids with very low income can't get heath care."

The 12-year-old program provides low-cost insurance to about 900,000 children and teens in low-income families that aren't poor enough to qualify for Medi-Cal. Adults in many of the families are working, but their jobs don't provide health coverage or don't cover dependents.

The Legislature reduced the Healthy Families budget by $128.6 million in its budget revision last month, and Gov. Arnold Schwarzenegger used his line-item veto to cut $50 million more.

The Bee political cartoonist Rex Babin sketches his take on the health care town halls going on across the country. What do you think about the town halls and Babin's cartoon? Let us know in the comments forum.

You can see a collection of Babin's work here.

The Service Employees International Union's state council today endorsed LT. Gov. John Garamendi to represent California's 10th District in the U.S. Congress.

The powerful union umbrella group said it's backing Garamendi because he's a "champion for universal health care, higher education, and economic opportunity."

SEIU state council executive director Courtni Pugh cited Garamendi's "lifelong support for working families," displayed when he was first a California legislator (1974-1988), then twice as insurance commissioner and now lieutenant governor.

The 10th District seat will soon be up for grabs in a special election triggered by the appointment of current Rep. Ellen Tauscher, a veteran Democrat, as undersecretary of state for arms control and international security.  The Senate approved Tauscher's appointment last week.

The 10th District district stretches from San Francisco's east bay area to the Sacramento-San Joaquin Delta.

The SEIU says it has more than 700,000 state and local government members across California who work in all 58 counties, including social workers, nurses, classroom aides, security officers, college professors, homecare workers, and janitors.

So says current author, Sen. Sheila Kuehl, in an op-ed for the California Progress Report.

Assemblyman Mark Leno, D-San Francisco, is moving on to the state Senate next month.

Photo: Assemblyman Mark Leno in March 2007. Credit: Sacramento Bee/ Brian Baer