Editorial: Reject irresponsible health care financing measures

The Mercury News and East Bay Times

October 13, 2018

Palo Alto’s Measure F and Livermore’s Measure U win the award for the most irresponsible initiatives before Bay Area voters this fall.

The measures were put on the ballot by SEIU-UHW, the union that represents 1,800 Stanford Medical Center workers, with the likely intent of gaining leverage in contract bargaining. The cities were targeted because Stanford has significant operations in Palo Alto and Livermore.

The measures would force every hospital and health care provider in the two cities to reimburse insurance companies and patients who are charged more than 15 percent above the industry-established cost of services provided.

That’s right. Palo Alto and Livermore would be required to take responsibility for overseeing the validity of hundreds of thousands of medical charges every year.

The initiatives present so many problems and potential unintended consequences that it’s hard to know where to begin. Suffice it to say that hospital financing and medical costs are complex issues best left to federal and state governments. A major industry medical cost overhaul with greater transparency is in order. But cities are not suited to take on the task.

Palo Alto and Livermore voters should reject the measures on Nov. 6.

Source: https://www.mercurynews.com/2018/10/13/edi...

No on Palo Alto Measure F, and leave our clocks alone!

By Diana Diamond

Palo Alto Weekly

October 11, 2018

If you haven’t seen enough “No on F” signs in town, or read all the editorials against Measure F (e.g., The Palo Alto Weekly’s “No, no, no on Measure F,”) let my voice join the chorus on this local Nov. 6 ballot measure

This was sponsored and funded by the SEIU (Service Employees International Union – e.g., city and government workers) and the United Healthcare Workers West), this dastardly measure would require Palo Alto city officials to permanently monitor and supervise all hospital and medical clinics and individual patients bills. The measure implies patients will pay less for medical services and if they pay too much they will get money back.

That’s a lie. If a patient has any insurance at all, any so-called rebate will go directly to their insurance company, and there is no mandate that the insurer would refund any money to the patient.

Measure F would cost the city millions to monitor health care. Specifically (and please read the following carefully), Measure F “would require cities to appropriate sufficient funds to implement, administer and enforce this regulator program.

Source: https://www.paloaltoonline.com/blogs/p/201...

Stanford Hospital, union spar over healthcare initiative

The Stanford Daily

October 10, 2018

Debate over Measure F, a Palo Alto ballot initiative that aims to curb healthcare costs in the city, has intensified as the November election approaches.

The measure would give the city of Palo Alto the authority to mandate that hospitals and other medical service providers reimburse patients and insurance companies who are charged more than 15 percent above the industry-established cost of the services provided.

Sponsored by the Service Employees International Union-United Healthcare Workers West (SEIU-UHW) — the union that represents over 1800 healthcare workers at the Stanford University Medical Center — Measure F collected over 3500 signatures of support in a petition submitted to the City of Palo Alto in May. It only needed 2407 to qualify.

Potential impacts on quality of care

Stanford publicly expressed opposition to the measure, positing that it threatens “Stanford Health Care’s ability to provide top-quality health care to patients from Palo Alto and across the region,” according to a statement published in Stanford News.

Source: https://www.stanforddaily.com/2018/10/10/s...

Editorial: No on Measure F, a disastrous idea

Palo Alto Daily Post

October 10, 2018

Measure F on the Palo Alto ballot is a reckless attempt by a labor union, SEIU-UHW, to gain more bargaining power by reducing medical services available to residents.

The measure would limit the amount health care providers could charge to 115% of what the union believes those services should cost. Of course the union defines “costs” differently than major health care providers, such as Stanford Hospital.

Stanford believes Measure F will cut its operating revenues by 25% or $1 billion a year. That would force Stanford to lay off workers, eliminate departments and reduce the amount of care it provides to the poor.

Emergency care

It’s important to understand that higher charges in some areas of the hospital go to fund departments that lose money, like the emergency room. By law, emergency rooms have to treat anyone who walks in the door, whether they can pay or not. A lot of emergency room bills are written off.

Source: https://padailypost.com/2018/10/10/editori...

Medical providers fear layoffs if Measure F passes, but union says it will promote transparency


Palo Alto Daily Post

October 7, 2018

Stanford Health Care leaders say that if the union-backed Measure F passes on Nov. 6, it could mean a $1 billion hit to the hospital’s $4 billion annual operating revenue — while SEIU-United Healthcare Workers West asks why a nonprofit hospital is sitting on $700 million in reserves.

The Palo Alto ballot measure would limit health care profits to 15% and would affect Stanford, Palo Alto Medical Foundation and smaller medical practices such as dentists and solo practitioner doctors.

The only medical practices that wouldn’t be affected are chronic dialysis clinics, children’s hospitals, free clinics, reproductive health clinics, VA facilities or facilities owned by a local or state government agency.

Providers would be required to issue a rebate or cost reduction on charges above 115% of the cost of direct patient care to those who pay for patient services.

In many cases, that means insurance companies would get rebates that they’re under no obligation to pass on to patients, meaning patient costs generally wouldn’t go down, according to Andy Coe, Stanford Health Care’s chief government and community relations officer.

Source: https://padailypost.com/2018/10/07/medical...

Q&A: Measure F and Stanford Health Care

Stanford News

An initiative on the November ballot in the City of Palo Alto would significantly affect the delivery of health care within the city, including at Stanford Health Care. Three university leaders discuss the issues behind the initiative and the impacts they foresee. 

Voters in the City of Palo Alto will see an initiative on their ballots this November that has significant implications for Stanford Health Care. 

If approved by voters, the initiative , known as Measure F, would limit the amount that health care providers in Palo Alto can charge commercially insured patients to 15 percent above the provider’s "direct" costs for patient care. 

Source: https://news.stanford.edu/2018/09/28/qa-me...

Stanford University statement on Measure F in Palo Alto

Stanford University

Stanford University opposes Measure F, an initiative on the November ballot in the City of Palo Alto, because it would threaten Stanford Health Care’s ability to provide top-quality health care to patients from Palo Alto and across the region.

Supported by the research engine of Stanford University, Stanford Health Care is one of the nation’s leading health care providers and is committed to providing the highest quality care to patients from Palo Alto, the Bay Area and around the world. As an academic medical center, Stanford Health Care often serves critically ill patients with complex medical needs. It receives more than 680,000 ambulatory visits and 53,000 emergency room visits annually, and offers the only Level 1 trauma center between San Francisco and San Jose.

Measure F proposes to limit charges to commercially insured patients at Stanford Health Care – as well as at Palo Alto Medical Foundation, Kaiser Permanente affiliates and other health care providers in the city – to no more than 15 percent above the “reasonable cost” of providing “direct” patient care. Such a policy is estimated to reduce Stanford Health Care’s budget by 25 percent, requiring significant cutbacks and the possible closure of many services and programs that are essential to high-quality health care in the local area.

The proposal generally would not affect what patients actually are charged for services, but rather would force Stanford Health Care to pay any rebates to insurance companies. Meanwhile, it would prevent Stanford Health Care from being paid for managers, technology and administrative expenses, and hospital services required by state law.

Measure F also would require the City of Palo Alto to create a costly new regulatory structure to enforce the new regulations.

Stanford also opposes Measure U, a similar measure in the City of Livermore, where Stanford Health Care operates ValleyCare Medical Center.

The university typically does not take positions on external political issues unless they directly impact its mission. These measures do. The patient care provided by Stanford Health Care is an integral part of Stanford University’s mission and is a major part of the university’s contribution to the health and quality of life of our region. As with any election issue, the university encourages individual members of the university community to review the facts of the issue and cast an informed vote, whatever their final judgment on the merits of the issue.

Protect patients and Palo Alto

The Stanford Daily

The Medical Community Opposes Measure F in Palo Alto—and You Should, Too

A recent op-ed in these pages advocated for Measure F, the Palo Alto ballot initiative, by criticizing Cardinal Care, the university-sponsored health insurance option for students. But the only connection Measure F has to students is to substantially weaken the Palo Alto health care institutions that serve them.

Cardinal Care, the university-sponsored health insurance option, is a comprehensive plan that provides students with a national network of physicians and facilities for both medical and mental health needs. These benefits also apply to students traveling domestically and internationally. Cardinal Care was developed specifically with students’ needs in mind ― and is regularly reevaluated to maximize benefits for a relatively healthy, young adult population.

PA Weekly: Editorial: No on F, Yes on E

September 21, 2018

No, no, no on Measure F

Initiative to give city oversight over health care pricing deserves overwhelming defeat

It is difficult to imagine a more poorly conceived idea to present to voters than the Measure F health care initiative pushed by the union representing health care workers throughout California, including Stanford Hospital employees.

The state Service Employees International Union (SEIU) United Health Workers (UHW) is attempting similar initiatives across the state. In Palo Alto the union turned in more than 3,500 signatures in late May, leaving the city scrambling to meet the deadline for either adopting the proposal as presented or placing it on the ballot for voters to decide this November. The council unanimously voted to put it on the ballot and, subsequently, to oppose it. A nearly identical measure appears on the ballot in Livermore.

The proposal is a wolf in sheep's clothing.

Not only will it fail to help consumers and create perverse incentives for medical centers to cut staffing levels, but it will also saddle the city with the need to hire a staff of experts to analyze and oversee the charges being made by almost all medical professionals, including individual practitioners, dentists and orthodontists practicing in Palo Alto. No city is equipped to regulate health care providers, and it is hard to conceive of any court upholding the constitutionality of local control over what local health care providers can charge for their services.

PA Weekly: Opponents gear up for battle over health care

Measure F would put Palo Alto City Hall in charge of regulating medical costs

by Gennady Sheyner / Palo Alto Weekly


On May 22, Palo Alto officials found themselves in the middle of a high-stakes battle that no one in City Hall signed up for, one that could have an impact on anyone providing or receiving health care in Palo Alto.

That's when a packet of more than 3,500 signatures arrived at the desk of City Clerk Beth Minor, ensuring that Measure F would appear on the November ballot.

Depending on whom you talk to, Measure F will either ensure quality health care in Palo Alto or force doctors, dentists and optometrists into permanent exile from the city.

It will either burden Palo Alto taxpayers with a new bureaucracy that could cost up to $2 million a year to administer or save them money by containing staggering health care costs.

Proponents say the initiative's aim is to pressure Stanford Health Care, which they claim is plagued by high infection rates, to shape up. Opponents say it seeks to pressure Stanford Health Care, one of the nation's leading medical institutions, to stand down while the measure's chief sponsor, the Service Employees International Union-United Health Workers, organizes employees at Stanford facilities throughout the Bay Area.

There is one thing that everyone agrees on: If it passes, the measure will transform both Palo Alto's local health care and City Hall, which today struggles to administer a simple business registry but which next year may find itself in charge of regulating the complex health care industry.

Source: https://www.paloaltoonline.com/news/2018/0...

The Mercury News: Patient cost initiative won’t lower hospital bills, opponents say

The Mercury News

September 6, 2018

Union-backed measure on November ballot aims to restrict hospital

A group fighting an initiative to restrict patient costs in Palo Alto claims that the measure would not lower hospital bills, but force the city to increase taxes or reduce services and even spur healthcare providers to relocate elsewhere.

C. Duane Dauner, director for the No on Measure F Coalition which is backed by local hospitals, said the initiative would not reduce costs to patients with private insurance or force insurers to issue rebates to patients who are charged too much for their care. The real reason the union is pushing the initiative is to boost membership, he said, adding that it will actually lead to hospital layoffs.

“Who wins under this initiative?” Dauner said. “The answer is nobody.”

The Palo Alto Accountable and Affordable Health Care Initiative, or Measure F — sponsored by Services Employees International Union-United Healthcare Workers West (SEIU-UHW) — would limit the amount that Stanford Hospital, Palo Alto Medical Foundation and other health care providers can charge patients to no more than 15 percent above the actual cost of providing care. The city would be required to regulate, administer and enforce any fines against healthcare providers, according to the city attorney.

RELEASE: Health Care Expert Concludes Measure F Will Force Pay Cuts And Layoffs At Stanford Health Care And Palo Alto Medical Foundation And Drive Small Medical Practices Out Of Palo Alto

FOR IMMEDIATE RELEASE | Wednesday, September 5, 2018                                                     CONTACT: Duane Dauner, (916) 812-7547

Palo Alto, CA – The Protect Palo Alto/No on Measure F Coalition today shared findings from independent health care expert Stephen Clark that the measure, which proponents claim will address hospital costs, instead will cut access to medical care by driving small medical practices out of the city and forcing layoffs and wage cuts at Stanford Health Care and Palo Alto Medical Foundation.

“Stephen Clark, who has more than 35 years of experience in health care finance, reimbursement, cost analysis, strategic planning and policy, has concluded that Measure F will do irreparable damage to Palo Alto,” No on Measure F Campaign Director C. Duane Dauner said. “Palo Alto voters are thoughtful and when they study the initiative, we are confident they will join our coalition, stand up for the community and reject Measure F.”

Following are Mr. Clark’s statements:

Measure F threatens Palo Alto’s health care system

“It is likely that the combination of the initiative’s direct financial burden, as well as the indirect costs of the accounting and reporting burden, may drive some providers from the area to either bordering cities or areas further from the community. This will not only impact the community in terms of having to seek health care in other areas but could negatively impact the community’s tax base, employment level and related wages.”

Measure F is designed specifically to harm Stanford Health Care and Palo Alto Medical Foundation

“The most significant impact will be incurred directly by Stanford Health Care due to its size and the breadth and level of services provided. The next largest group that could be impacted by the ballot measure is the medical clinics operated by the Palo Alto Medical Foundation (PAMF).”

Measure F consequences: wage cuts, reduced community benefit contributions and layoffs

“It is likely that most of the significant cost reductions will occur in the areas of capital expenditures, employee compensation and community benefit contributions. It is likely that cuts in employee compensation would be accomplished with a combination of pay reductions and layoffs.”

“Mr. Clark’s impartial review clearly demonstrates Measure F’s harmful consequences, which demonstrate why physicians, hospitals, other health care providers and consumers are urging voters to defeat the initiative on November 6. We need to increase access to care, not destroy Palo Alto’s medical community. Voters can protect Palo Alto by voting no on Measure F,” Dauner concluded.

For more information about Measure F, please visit http://www.protectpaloalto.org.


Letter to the editor: Stand up for health care

Palo Alto Weekly

June 8, 2018


On Monday night, the Palo Alto City Council is expected to put a union-sponsored initiative on the November ballot. If passed, it would have significant negative consequences for patients who rely on the care they receive here in our community.

The initiative, by Service Employees International Union - United Healthcare Workers West (SEIU-UHW), doesn't address health care costs or limit prices charged to patients who have insurance. It doesn't fund preventive care programs that result in a more efficient system or healthier society. Instead, it mandates Palo Alto's hospitals, medical clinics and doctors pay rebates to insurance companies, without requiring rebates be passed on to patients. Nothing improves patient safety or makes care more accessible.

The initiative also applies to local dentists, optometrists and other small, specialty practices in Palo Alto. The financial impacts are likely to force many to cut back, close or make the difficult decision to relocate away from Palo Alto.

Palo Alto Weekly: Battle over health care costs hits Palo Alto


by Gennady Sheyner / Palo Alto Weekly

June 13, 2018

Palo Alto City Hall became an unlikely frontier in a broader battle over health care costs Monday night, when a crowd of medical professionals packed into the Council Chambers to debate the merits of a citizen initiative that would cap how much local hospitals can charge patients.

Dozens of supporters and opponents of the initiative attended the City Council meeting to hold competing signs and sound off on the measure, which is being spearheaded by the Service Employees International Union -- United Healthcare Workers West and which will would prohibit Stanford Health Care and other local medical providers from charging patients more than 115 percent of the "reasonable cost of direct patient care."

Source: https://www.paloaltoonline.com/news/2018/0...