HEALTH ACCESS ALERT: Monday, March 17, 2013
CALIFORNIA LEGISLATURE STARTS CONSIDERING NEW HEALTH CONSUMER PROTECTIONS
* Health reform continues beyond Affordable Care Act implementation with several bills to provide better oversight on insurers, hospitals, and the health system.
* Many bills, including ones sponsored by Health Access California, would help consumers once they get coverage, with continuity of care (AB369 & SB1100), network adequacy and timely access to doctors and specialists (SB964), prescription drug cost sharing (AB1917), avoiding junk coverage (AB2088), and more.
* Coverage expansion efforts continue with SB1005 to allow all Californians to get the same levels of help to access and afford care, regardless of immigration status, by extending state-only Medi-Cal and creating a “mirror marketplace” to complement Covered California.
* Bills to be heard in Assembly or Senate Health Committees in March or April, and if passed would advance to Appropriations and floor vote of first house in May. Bill list below includes legislation of concern, where consumer advocates seek amendments.
* As CA Leads Nation In Enrollment, Advocacy Still Needed on Successes and Improvements; STORIES NEEDED of California’s Experience With Covered CA & Obamacare
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Last week, the California Legislature passed urgency legislation on a bipartisan vote to allow patients who had to change health plans in January-March of 2014 to continue with their health provider during their course of treatment. This continuity of care legislation, AB369(Pan), sponsored by Health Access California, is now on the Governor’s desk.
But while that measure is passed, many new bills have been introduced in the past few months of interest to consumer, community, and health organizations, which will now start to go through the regular legislative process, starting with first policy committee hearings in March and April.
Below is a bill list of health reform legislation, which includes positions taken by Health Access California, the statewide health care consumer advocacy coalition. The health bill that has gotten the most attention and grassroots enthusiasm from health and community groups this year has been the #Health4All bill, SB1005, by Senator Ricardo Lara and many co-authors, to extend for all California’s remaining uninsured, including undocumented immigrants, by extending state-only Medi-Cal and creating a “mirror marketplace” to complement Covered California.
Many bills help patients once they get into coverage, from requiring better oversight on network adequacy and timely access to care, to additional consumer protections on prescription drug cost-sharing, to extending continuity of care provisions on an ongoing basis. Other bills provide additional transparency and oversight of insurers and hospitals, of their charges and their practices. In addition to measures sponsored and supported by Health Access California, the bill list below also include legislation that has raised concerns among consumer advocates. Please contact us for more information.
HEALTH ACCESS CALIFORNIA BILL LIST
Coverage Expansion
SB1005 (Lara) seeks to extend access to affordable coverage to all Californians, without regard to immigration status, by offering the same financial help as the ACA provides to Californians excluded under the federal law. The bill creates a state-only Medi-Cal program for those who are barred from Medi-Cal by reason of immigration status, covering kids up to 266%FPL and adults up to 138%FPL through state-only Medi-Cal. It also creates a parallel Exchange or “mirror marketplace” that would provide immigrants with the same coverage options and subsidies as those covered through Covered California. STRONG SUPPORT.
Insurance Consumer Protections
NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to conduct surveys of health plans for timely access and network adequacy to be done more frequently, and by book-of-business, separately for Medi-Cal managed care and Covered California plans, to ensure access to care for patients in those programs. It also requires separate surveys until five years after implementation of the major Medi-Cal managed care transitions, including not only Healthy Families but also the seniors and persons with disabilities, the dual eligibles (both Medicare and Medi-Cal) and the rural transition. SPONSORED by Health Access California.
PRESCRIPTION DRUG COST SHARING: AB1917 (Gordon) spreads out the cost of expensive prescriptions over a year, to better help those with HIV/AIDS, cancer, MS, and other diseases manage out-of-pocket expenses. Consumers would still have the annual out of pocket limit of no more than $6,350 for an individual or $12,700 for a family under the ACA, but the cost of any one drug can’t be more than 1/24th of the annual limit or about $265 per copay. This means multi-tier drug formularies in which some high-priced drugs are on a fourth tier that involves 20% co-insurance won’t burden patients all at once. Under this bill, a patient might still end up owing the annual out of pocket limit but at least the cost will be spread out over a year. SPONSORED by Health Access California.
JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez), while not banning limited benefit plans, makes them supplemental to employer-based coverage. While the California Insurance Code allows the sale of “insurance” that provides very limited benefits, such as cancer-only policies and hospital fixed amount indemnity policies that pay $100 or $200 a day when someone is hospitalized, current California law allows it only as supplemental to essential health benefits in the individual and small employer markets. This bill extends this consumer protection to large employer coverage, closing a loophole for employers to possibly avoid compliance with the full intent of the ACA. SPONSORED by Health Access California.
CONTINUITY OF CARE: SB1100 (Ed Hernandez) will be amended to provide continuity of care protections for consumers who change their individual coverage—something that was not possible for many until the ACA. While Californians with employment-based coverage now have the right to continuity of care if in the midst of treatment or had a serious condition when their coverage changed, this bill extends this protection to those with individual coverage including in Covered California. (AB369 Pan, sponsored by Health Access California and pending on the Governor’s desk, would provide continuity of care protections specifically for consumers with policies cancelled Dec. 1, 2013-March 31, 2014.) SUPPORT.
SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the Affordable Care Act which was enacted in 2012 and 2013. SUPPORT.
SB1034 (Monning) would delete 60 day waiting period for California insurance. California law would not permit any waiting period as a result of a pre-existing condition. Federal law would permit employers to impose a waiting period of as much as 90 days for workers and dependents. SUPPORT.
AB1962 (Skinner) would impose on dental-only plans a medical loss ratio that would specify a percentage of premium that must be spend on actual patient care. t. It requires specialized dental-only plans to have the same medical loss ratios as for medical coverage, that is, 85% for large group and 80% for individual and small group coverage: Specialized health plans that offer benefits such as dental or vision are exempt from many of the consumer protections of federal and state law. The bill is sponsored by the California Dental Association. SUPPORT IF AMENDED.
SB1053 (Mitchell) would add provisions relating to contraceptive coverage to the essential health benefits. It is an attempt to implement and improve provisions of the ACA related to contraceptive benefits in state law. Further amendments are needed to reconcile with state law. It is co-sponsored by NHELP and some family planning clinics. SUPPORT IF AMENDED.
Cost/Quality Transparency
AB1558 (Roger Hernandez) would provide claims data to the University of California so that UC can do studies on cost and quality. SUPPORT.
SB1182 (Leno) would implement large group rate review for rate increases in excess of 5%. It also provides claims data or other detailed data to large purchasers. SUPPORT.
Hospital Oversight and Consumer Protections.
SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT
SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 5% of the family’s income; allowing underinsured individuals with high health care costs (defined as over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer; adding Covered California as a source of coverage; and requiring the debt collection policy to apply to any affiliates or subsidiaries or external collection agency used by the hospital. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers affected by the law. SUPPORT.
AB1952 (Pan) requires certain nonprofit hospitals to spend 5% of their net patient revenue on “charity care” (undefined) or contribute that amount to the state to supplement the Medi-Cal program. Sponsored by SEIU United Healthcare Workers West. SUPPORT IF AMENDED.
AB503 (Wieckowski/Bonta) requires the reporting of community benefits and that such reports be standardized; and defines “charity care” as care provided without expectation of payment. Sponsored by the California Nurses Association and the Greenlining Institute. SUPPORT IF AMENDED.
Medi-Cal
AB1759 (Pan)/AB1805 (Skinner) would restore the remaining 10% reimbursement rate cuts to fee-for service Medi-Cal providers, a cut made in 2009-10 that was delayed by legal actions but is just being implemented this year, at the same time we are expanding Medicaid under the ACA. At a time of surplus, it would be less than $250 million to cancel this cut that was made in the worst moments of California budget crisis. SUPPORT.
SB1124 (Hernandez) will be amended to address and limit Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. It is co-sponsored by Western Center on Law and Poverty and California Advocates for Nursing Home Reform. SUPPORT.
AB2025 (Dickinson) would change the income eligibility for Medi-Cal for seniors and persons with disabilities. This bill is sponsored by Western Center on Law and Poverty. This has not been updated in decades. SUPPORT.
AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.
Prevention
SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. It is sponsored by California Pan-Ethnic Health Network. SUPPORT.
Bills of Concern
AB2400 (Sebastian Ridley-Thomas) allows doctors to refuse to serve Covered California or Medi-Cal patients. It prohibits a contract between a health plan and a physician or physician group unless the physician affirmatively agrees to all contract terms for each and every product and line of business. If a physician opposed the Affordable Care Act or the Medi-Cal expansion, AB2400 would give those physicians the ability to refuse contracts to serve these patients. Existing California law requires health plans to provide notice and negotiate with physicians if there is a material change in a contract: AB2400 takes this a step further by requiring physicians to “affirmatively agree” to terms for each and every product and line of business. The bill is sponsored by the California Medical Association. OPPOSE.
AB1877 (Cooley) would create a “Vision Care Access Council” that would operate a parallel exchange to offer adult vision coverage. While consumer groups actively support Covered California offered vision plans, AB1877 does not allow an active purchaser role and does not permit standardization of benefit designs, two of the hallmarks of Covered California’s consumer friendly approach. AB1877 also does not include conflict of interest protections for the governing board of the Vision Council, another key provision of the California Exchange. OPPOSE UNLESS AMENDED.
AB1829 (Conway) would prohibit the Exchange from hiring or contracting with individuals with specified crimes, including ones not relevant to the work performed. Community groups believe that this worsens racial disparities, particularly for boys and men of color. Covered California was given discretion to allow individuals with past criminal records to provide enrollment assistance if Covered California found mitigating circumstances or if the individual had paid their debt to society. OPPOSE.
AB1830 (Conway), AB1560 (Gorell), and SB974 (Anderson) would require Covered California to obtain permission from consumers before sharing their names. Balancing consumer privacy rights with the need to do effective outreach and enrollment requires further amendments. This goes further to prevent outreach grantees and navigators from following up on leads. OPPOSE UNLESS AMENDED.
AB2367 (Donnelly) creates a tax credit for individuals with individual coverage with higher premiums in an amount equal to the difference in the premiums paid in the prior year. It provides this tax credit even if the increase in the premium occurred because of an increase in rates unrelated to the ACA, the increase in the premium occurred due to an increase in the individual’s age (which occurs annually), or the increase in the premium occurred because the prior coverage was junk insurance and is now comprehensive coverage. OPPOSE.
SB1376 (Gaines) would create a tax credit for individuals of 50% of the premium paid for individual health insurance for an individual whose coverage was cancelled between Dec. 31, 2013 and Dec. 31, 2014. This tax credit would be available whether or not the individual was able to get cheaper coverage or better coverage or both. OPPOSE.
AB2576 (Harkey) would conform California law to federal law with respect to health savings accounts. OPPOSE.
SB1173 (Gaines) would require the Insurance Commissioner to accept any rate decrease without review or modification. Applies to rate decreases for health insurance. OPPOSE
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