The Ebola virus has yet to hit California, but it’s likely coming, according to state health officials. They say the state is prepared, but nurses on the health care front lines aren’t so sure.

“Given the spread of Ebola in West Africa and world travel, we should not be surprised if sometime in the near future a person in California is suspected of Ebola. And California needs to be prepared,” Assemblyman Richard Pan said in his opening remarks as chairman of a Nov. 18 Assembly Health Committee informational hearing on Ebola.

“Certainly the public is concerned about this disease,” said Pan, who is also a pediatrician at a Sacramento clinic. “In the past months I personally have been asked about Ebola while walking in the community, at meetings and in my clinic. People want reassurance that California is ready, that we will contain the disease and keep their families safe.”

State health officials are monitoring people in California who have traveled to the four main Ebola-infected countries: Liberia, Sierra Leone, Guinea and Mali.

“As of Nov. 17 there are 26 returning travelers being monitored in 12 counties across California, including two returning health care workers,” said Gil Chavez, the California Department of Public Health chief epidemiologist. A total of 58 people have been monitored since the early detection effort began several weeks earlier. “We have reached a steady state where the number of new returning travelers is roughly equal to the number passing the 21-day monitoring period,” he said. “The great majority of returning travelers continue to be in the low-risk category.”

‘Largest in history’

Department of Public Health Director Ron Chapman said “the outbreak we are seeing now is the largest in history.” But he assured the committee that state officials “are working very hard” with both local and national public health agencies to keep tabs on suspected Ebola patients. “We are receiving very, very small numbers of travelers compared to states on the East Coast,” he said. “There’s no suspected or confirmed cases to this point in California.”

But it may be only a matter of time before that changes, according to Bela Matyas, representing the Health Officers Association of California.

“From a strictly pragmatic standpoint, given the size and duration of this outbreak in Africa, the risk of Ebola virus disease in California is real,” he said. “Ebola can be imported to California through a visitor from one of the impacted countries, a returning health care worker, or a person infected by Ebola elsewhere in the U.S. If a case of Ebola occurs in California, limited local transmission is possible. Although, obviously, we would do everything we can to prevent that. But sustained transmission of Ebola in California is highly unlikely.”

When those Ebola patients do arrive, hospitals will be ready, according to Cheri Hummel, vice president of disaster preparedness for the California Hospital Association, which represents 400 hospitals in the state. “I can attest to them being prepared and ready for an Ebola case,” she said. “California hospitals are required on an ongoing basis to prepare for a variety of emergencies, including infectious diseases. They have well established plans for infectious disease control.”

The primary care facilities for Ebola patients in California are the five UC medical centers in Davis, Irvine, Los Angeles, San Diego and San Francisco.

“[The] medical centers have been engaged in probably one of the most extraordinary planning and training endeavors that I’ve been involved in 41 years in health care,” said Carol Robinson, chief patient care services officer for the UC Davis Medical Center. “To date we have conducted more than 1,200 hours of training … for safely donning and doffing PPE [personal protective equipment]. And it’s being conducted in 90-minute sessions, eight hours a day, five days per week.

“We have been listening to our nursing staff as they have participated in the selection and training of our equipment. We are also consulting with our infectious disease experts for recommendations to provide a safe, sufficient protection; and it’s based on science and evidence. Nurses, for example, provided crucial insights in this protective equipment as they have practiced putting it on and taking it off. Our donning and doffing process is probably the most critical. And the nurses have to be expert at it.”

Kaiser ready

Earlene Person, a nurse at Kaiser Permanente in Oakland, believes her hospital is ready.

“In all my years as a health care provider, I haven’t seen the public as concerned about a health issue since the outbreak of AIDS in the 1980s,” she said. “I share their concern. I want to be safe. I want my family to be safe. And I want my patients in my community to be safe. And as health care workers we have the right to get the training and the equipment we need to protect ourselves from Ebola.

“The good news is that there have been no reported cases of Ebola in California. We hope it remains that way. We are the largest state in the nation, and a case of Ebola could arrive on our doorstep any day. So we have to be ready. I am happy to report that if an Ebola patient were to arrive at my hospital tomorrow, we have the proper training, equipment and procedures in place to keep everyone safe. That means patients, workers in the community. At Kaiser we consistently receive updates on new information and safety preparation.”

But not all nurses are so confident. Ten of them spoke during the public comments period at the end of the meeting to voice their concerns. Many were grateful for Cal-OSHA’s new guidelines for protecting hospital workers’ safety when dealing with Ebola patients. Those guidelines were issued, they said, in response to their complaints about inadequate safeguards.

“Upon seeing the lack of optimal personal protective equipment and lack of response from our facilities, we went to the governor demanding action,” said Kathy Donahue. “He listened intently, heard the nurses’ reports of how deeply unprepared and resistant hospitals were. And he moved to protect the public, the nurses and other health care workers. Absent scientific consensus that a particular risk is not harmful, especially one that can have catastrophic consequences, the highest level of safeguards must be adopted. That’s a sharp contrast to the profit principle that has guided the response of most hospitals.”

Nurses

Malinda Markowitz, a co-president with the California Nurses Association, is not confident adequate protections are in place to monitor potential Ebola patients in the community. “Isn’t it true that we are not always keeping track of patients that have tuberculosis and they fall out of contact?” she asked. “So how are we to assume and be assured that an Ebola patient would be any different than patients that have tuberculosis? How can they assure that an Ebola patient won’t be the same, and we would lose the contact and they would be out in the public possibly infecting the community?”

Zenei Cortez, another CNA co-president, noted how easily Ebola can be spread. “All it takes is just one drop or one splash of vomit to infect the health-care worker or the nurse,” she said. “I urge you not to allow the industry to water down the mandated regulations so that our hospitals, our employers, would be responsible for all the workers. They can very well afford the personal protective equipment that we need to take care of our patients. The nurses are relentless, and we will make sure that all patients, the public and all workers are safe. And not one more life will be wasted and not one nurse will be infected.”

Katy Romer, a nurse at Kaiser Permanente in Oakland, doesn’t believe hospitals are ready. “It is crucial that you listen to the people on the front lines that actually know what’s happening in the hospitals,” she said. “Kaiser Oakland is saying they are completely prepared right now. The reality is that they are not completely prepared right now. There is tremendous variability from facility to facility. But even within my facility there is tremendous variability within department.

“If you’re not training with the highest level of equipment, you’re not prepared to deal with this disease. You’re going to be putting yourself, the patients and the community at risk. If you go in the hospital and you’ve had an exposure and then you have a nurse that’s not prepared to care for you, you’re in danger. And your whole community and your family is in danger. We don’t want that to happen to anyone.”

Concerns

Pan concluded the two-hour hearing by acknowledging the nurses’ concerns. “I do take to heart that we do need to surely know what’s really going on on the front lines that can be a little different than what the policy makers think,” he said. “I’ve experienced that already in this position as a front-line doctor. So I think that’s an admonition well taken.”

In his opening remarks, Pan noted Ebola is not the only contagious disease worthy of increased attention and precautions.

“The influenza pandemic of 1918 actually killed more people worldwide than all the soldiers and sailors that died in World War I, just to give you some context here,” he said. “But infectious diseases are not a problem of the past; they are problem in the very present. In fact, here in California this year we are going through another pertussis epidemic.

“We have faced record numbers of measles and West Nile Virus infections. Valley Fever continues to be a significant problem in the Central Valley. And last flu season, as we are about to approach another flu season, 404 people died of the flu who were under 65 years of age of influenza. We actually don’t track people who are over 65.”

At the same time, however, California’s health care spending has not kept up, he said.

“Last February this committee held a hearing on California’s public-health infrastructure and our state’s preparedness to halt the growing threat of contagious diseases,” said Pan. “That hearing revealed the local public health departments and state laboratories had suffered significant cuts during the economic downturn. In Sacramento County alone, 135 public health positions were eliminated between 2005 and 2010. And support for identification surveillance and emergency response were particularly vulnerable because they depend primarily on discretionary funding in government budgets.”

1) Isn’t doing that well signing up young people, who are essential to the economics of the Affordable Care Act, despite a heavy marketing campaign aimed at them.

2) Is having trouble signing up Latinos, who are a primary target of the ACA.

The story mentions that Kaiser Permanente has signed up 8,250 state residents. It doesn’t mention that Kaiser has cancelled the policies of 160,000 such residents. Nor does it mention that while 80,000 people have signed up with Covered California, more than 1 million Californians have had their policies cancelled.

The story has one anecdote about premiums, and it is a positive one:

“San Jose couple Rosario and Justine Consiglio, both 57, say they were surprised at how much they saved when they enrolled in a Gold-level plan from Blue Shield of California last week. Their monthly premiums will drop from $1,100 now to $850 next year, helped by a premium subsidy. And they will pay far less out of pocket for prescription drugs and other medical expenses.

“This is a much better healthcare plan than we had previously, and we’re paying a lot less,” Rosario Consiglio said. “I wasn’t sure how all this would affect us.”

What about the evidence that Californians in general will pay far more under Obamacare? It’s never mentioned.

And how does Chad Terhune describe this overall picture in the lead? He depicts Covered California as being off to a great start, a “bright spot” for the Obama administration nationally.

Sigh. This isn’t journalism. This is ideological cheerleading.

The pathetic excessive paternalism of this judgment is bad enough; you American idiots don’t know what’s good for you, etc. But objectively speaking, it’s just not true that the people with cancelled plans all had “bad” policies with high deductibles and little coverage. The 160,000 policies that Kaiser Permanente cancelled in California reflected a big range of coverage, including at least 30,000 policies that could never be depicted as “crappy” or “cut-rate.”

ProPublica offers a telling example of such a policy in a story headlined “Loyal Obama Supporters, Canceled by Obamacare”:

“San Francisco architect Lee Hammack says he and his wife, JoEllen Brothers, are cradle Democrats.’ They have donated to the liberal group Organizing for America and worked the phone banks a year ago for President Obama’s re-election.

“Since 1995, Hammack and Brothers have received their health coverage from Kaiser Permanente, where Brothers worked until 2009 as a dietitian and diabetes educator. ‘We’ve both been in very good health all of our lives – exercise, don’t smoke, drink lightly, healthy weight, no health issues, and so on,’ Hammack told me.

“The couple — Lee, 60, and JoEllen, 59 — have been paying $550 a month for their health coverage — a plan that offers solid coverage, not one of the skimpy plans Obama has criticized. But recently, Kaiser informed them the plan would be canceled at the end of the year because it did not meet the requirements of the Affordable Care Act. The couple would need to find another one. The cost would be around double what they pay now, but the benefits would be worse.”

Reporter expected horror story to be false

ProPublica reporter Charles Ornstein, in a bit of unusual but still telling candor, admits he was inclined to doubt the truth of Obamacare horror stories. But he found the Hammacks’ tale credible.

“I tried to find flaws in what Hammack told me. I couldn’t find any.

“—The couple’s existing Kaiser plan was a good one.

“—Their new options were indeed more expensive, and the benefits didn’t seem any better.

“—They do not qualify for premium subsidies because they make more than four times the federal poverty level, though Hammack says not by much. …

Ornstein notes the basics of the Kaiser plan being cancelled vs. the plan Kaiser recommended in its place:

“It carried a $4,000 deductible per person, a $40 copay for doctor visits, a $150 emergency room visit fee and 30 percent coinsurance for hospital stays after the deductible. The out-of-pocket maximum was $5,600.” …

“[The] new Kaiser plans  would cost nearly $1,300 a month for the two of them (more than $15,000 a year).

“And for that higher amount, what would they get? A higher deductible ($4,500), a higher out-of-pocket maximum ($6,350), higher hospital costs (40 percent of the cost) and possibly higher costs for doctor visits and drugs.”

No, Covered California did not offer relief

At this point in stories of this type, defenders of Obamacare will always say, “But under the ACA, they have options. What about the other options?” And if reporters are worth a damn, they will look at the other options — and almost always find out what Ornstein did: Other options are very costly, too.

“When they shopped around and looked for a different plan on California’s new health insurance marketplace, Covered California, the cheapest one was $975, with hefty deductibles and copays.”

Read Ornstein’s entire story for plenty more details about the latest chapter in “Obamacare Lies: The California Edition.” It’s going to end up a really, really long book.

SACRAMENTO — When the Legislature returns from its July recess, it will take up several health-care bills. A top one will be SB 746, by state Sen. Mark Leno, D-San Francisco. It would require new data reporting requirements for large group market health plans. It aims for greater transparency of health care costs to help contain the rising cost of health insurance.

At the Assembly Committee on Health hearing on July 2, Kaiser Permanente opposed the bill. The committee passed it anyway that day, 12-6.

“Only with this information can we all better contain the cost,” Leno said at the hearing, which I attended.  “This bill would require all health plans to publicly disclose aggregate information about the rates for large purchasers.”

It would require insurers selling coverage to employers with 50 or more employees to provide detailed information to the Department of Managed Health Care about how and why rates would be raised. Additionally, that information would be available to the public so consumers actively could question and track rate hikes.

Opposition from Kaiser 

The bill received strong opposition from Kaiser. The company claimed that, even though some amendments made improvements, the bill still unfairly targets Kaiser.

“We have no objections to transparency or sharing info with customers, but the sponsors of the bill are trying to change our business model and care delivery system,” said Teresa Stark, a legislative advocate for Kaiser.

Stark said Kaiser’s integrated health system is different from other health insurance, so they cannot provide the same type of information.

“The bill is meant to send a message to Kaiser: Kaiser, you are doing everything wrong,” she said.

Leno disagreed and said the amendments by the Assembly Committee on Health made sure the bill doesn’t target any specific health plan.

Charles Bacchi, executive vice president of the California Association of Health Plans, also spoke in opposition. He called the bill unnecessary and expensive, as it is not a requirement of the Affordable Care Act, usually called Obamacare.

“Health care plans are in the middle of implementing the most important changes to our health care system since Medicare,” Bacchi said. “There’s much to be done. We’re focused on getting that done and we think we should be spending our time focusing on the ACA.”

Stark added that the DMHC has never questioned Kaiser regarding its rates and transparency.

“We do need to make some changes in how we help our customers and purchasers understand their health care costs but we don’t need a bill to tell us that,” Stark said.

Background and motivation for SB 746

Assemblymember Dan Logue, R-Chico, asked Leno why there was a need for this bill.

Leno said that the San Francisco health service system found that, between 2010-2012 Kaiser was getting $87 million more from San Francisco members than it costs to serve them. Additionally, San Francisco County found rates increased by 11 percent, yet people’s use of hospitals, doctors and prescription services decreased by 16 percent.

Sponsors of SB 746 are Unite Here and the United Food and Commercial Workers Union, Western States Council. Also supporting the bill were representatives from Health Access California, a statewide health care consumer advocacy coalition.

“We need good information to negotiate on health care costs and also to provide better care,” said Beth Capell, legislative advocate for Health Access.

HAC sponsored Leno’s previous bill on health care rate transparency, SB 1163, which he authored in 2010 in response to the ACA.

SB 1163 requires health plans and health insurers to file with the California Department of Insurance and the DMHC rate information for individuals and small group plans and polices 60 days prior to implementing rate changes.

Leno said SB 1163 as an example of how information transparency helped lower costs.

“We know that transparency works,” Leno said. “We’re told that within the first two years, as a result of that bill, over $300 million has been saved.”

Leno said SB 746 addresses large group purchasers of health insurance, which SB 1163 did not.

The Assembly Committee on Health analysis of SB 746 said the DMHC indicates that Kaiser sets rates differently than other insurers.

SB 746 next will be heard after the summer recess ends in August in the Assembly Committee on Appropriations.