HEALTH ACCESS UPDATE: Sunday, September 30, 2012
BUT VETOES AND DELAYS INDIVIDUAL INSURANCE MARKET REFORM BILLS
GOVERNOR BROWN SIGNED KEY BILLS THAT:
- SET ESSENTIAL HEALTH BENEFIT STANDARDS FOR HEALTH PLANS, HELPING PREVENT “JUNK INSURANCE” AND “FEAR OF THE FINE PRINT”;
- INFORM CALIFORNIANS OF COVERAGE OPTIONS DURING LIFE CHANGES;
- REFORM THE SMALL GROUP INSURANCE MARKET AND PROTECT SMALL EMPLOYERS FROM PREMIUM SPIKES WHEN WORKERS GET SICK
- AND MORE…
GOVERNOR VETOED BILLS, OPPOSED BY INSURERS, TO PREVENT DENIALS DUE TO PRE-EXISTING CONDITIONS; THESE BILLS NOW NEED TO BE PASSED ON AN EMERGENCY BASIS FOR CALIFORNIA TO BE READY FOR REFORM IN JANUARY 2014
NOW MORE WORK TO DO IN SPECIAL LEGISLATION SESSION STARTING THIS FALL
These signed consumer protection bills to implement federal health reform would set essential health benefit standards for health plans; reform the small group insurance market; and better inform Californians about their new coverage options in 2014. But key vetoes mean there is much more work to do for California to be ready for reform, including in a special legislative session to start this winter.
DISAPPOINTING VETOES: In particular, the Governor vetoed two bills to reform the individual insurance market, delaying action on those measures until a special session scheduled to start in December.
Health and consumer advocates were disappointed that Governor Brown vetoed the two bills opposed by insurers that would implement key Affordable Care Act consumer protections, including the provisions that no Californian is ever denied for pre-existing conditions or charged more because of their health status. In his veto message, Governor Brown wanted the bill to be more explicitly conditioned on the federal Affordable Care Act–something the legislative authors believed they had included and addressed.
In the veto message of SB961(Hernandez) and AB1461(Monning), the Governor said he “realized how important it is to align our individual health insurance market rules with the” federal law, and “this bill got almost all the way there.” Advocates state that the veto delays implementation, and stress that it is imperative that these bills are redone in a legislative special session as soon as possible, in order for Californians to get the benefit of reforms scheduled to start in January 2014.
Also vetoed was SB970(DeLeon), sponsored by Western Center on Law and Poverty, which would better integrate health enrollment with human services. In his veto message, Governor Brown stated the bill was “well-intentioned but overly prescriptive.”
Historic bills signed include SB951(Hernandez) and AB1453(Monning), which would define an “essential benefits package” for health plans, so consumers have more confidence that their coverage is comprehensive.
This has been a major priority for health and consumer advocates over many years, to help prevent consumers from being trapped in junk insurance that excludes key treatments and leaves families in medical debt–and even to help people picking a plan no longer have “fear of the fine print” that a plan will arbitrarily exclude the treatment they eventually need.
Also signed was AB1083(Monning), sponsored by Health Access California and Small Business Majority, would reform the small employer market to be aligned with the ACA. In part, these reforms prevent small businesses from seeing spikes in insurance premiums if their workers get sick.
Another signed bill, sponsored by Health Access California, will better inform Californians about their new coverage options during life changes. AB792(Bonilla) would require that consumers are informed of their coverage options when losing coverage–such as during a job change, divorce, adoption, and other circumstances. This bill represents an innovative approach to ensuring Californians know about their new coverage options. Advocates argue that getting more Californians enrolled is imperative not just to get them needed care, but to bring in federal dollars to our state’s health system and economy.
While the federal law provides new tools, resources, and a framework for historic improvements in our health care and coverage–state action and legislation is needed to make it operational and successful in California. This now-concluded legislative session made significant progress in this regard–California must still be considered a lead state in implementing health reform, but much more needs to be done, on an emergency basis, in order for California to be ready prior to January 2014, as scheduled.
The Governor had already called for a special session of the legislature, beginning in December with a newly-elected Assembly and Senate, to deal with final health reform implementation issues prior to 2014. The work on individual insurance market reform is now added to a list that include changed eligibility and enrollment rules, Medicaid expansion, the possibility of establishing a Basic Health Plan, and more
A full list of health reform-related bills that made it to the Governor’s desk is available on the Health Access website:
** SB961 (Hernandez)/AB1461 (Monning) REFORMING THE INDIVIDUAL MARKET: Prevents insurers from denying or discriminating for pre-existing conditions, and otherwise conform and phase-in new insurance market rules for individuals who purchase insurance on their own. Limits different premiums based on age to 3:1. Veto message.
** SB970 (DeLeon) HORIZONTAL INTEGRATION WITH HUMAN SERVICES: Helps individuals applying for public programs apply through an integrated no wrong door approach, whether applicants are interested in social services or health programs. Veto message.
Consumer Protections and Insurance Reform:
** AB1453 (Monning)/SB951 (Hernandez) ESSENTIAL HEALTH BENEFITS: Protects consumers from underinsurance and junk insurance by requiring health plans to cover a set of minimum essential health benefits equivalent to the Kaiser Small Group HMO.
** AB1083 (Monning) REFORMING THE SMALL GROUP MARKET: Puts in place the new insurance oversight and consumer protections in the market for small employers, preventing overcharging for small businesses with sicker workers, etc.
* AB1526 (Monning) IMPROVING THE HIGH RISK POOL: Reduces premiums in the Major Risk Medical Insurance Program (MRMIP) to better align the program with PCIP, the federally funded high risk pool under the ACA.
* SB1410 (Hernandez) INDEPENDENT MEDICAL REVIEW: Improves the process by which consumers appeal denial of care decisions by making the process more robust and transparent. Also requires collection of race, ethnicity, and language data to help determine whether health equity issues need to be addressed.
* AB1761 (Perez) EXCHANGE MISREPRESENTATION: Prohibits any individual or entity from falsely representing themselves as the California Health Benefits Exchange.
** AB792 (Bonilla) COVERAGE DURING LIFE CHANGES: Provides notice so that Californians can easily sign up for coverage during key life changes. Requires California consumers are provided information about the Exchange upon losing coverage for due to job change, divorce, separation, unemployment, adoption, or other life circumstances.
* AB174 (Monning) SYSTEMS INTEGRATION: To support a Health and Human Services Automation Fund to better integrate information systems between health and tax agencies to allow for more seamless eligiblity and enrollment efforts.
* AB1580 (Bonilla) ELIGIBILITY AND ENROLLMENT: A follow-up to last year’s AB1296 to streamlining eligibility and enrollment processes in Medi-Cal and other health programs.