So now that we established the barriers for individuals to get available, affordable, and automatic health care coverage in a previous post, let’s look at the various legislative proposals, and how they have remove or at least lessen those barriers.
SB840 (Kuehl) would make coverage more available, affordable, and automatic. It continues to be the gold standard in our advocacy.
Available? Every Californian who met the residency requirement would be eligible.
Affordable? People would pay through taxes, based on payroll taxes, rather than the costs based on job type or how sick we are.
Automatic? By doing the financing through the tax system, and with the simple eligibility, sign-up becomes automatic. Medicare has an easy, one-time sign-up, which gets all but a handful of folks to enroll.
AB8(Nunez/Perata)’s framework would take strides toward removing the barriers to get employer-based coverage, public program coverage, or insurance in the individual market. It has the virtue of building on what works in the current system and not impacting the coverage that people currently have, and avoids some of the political and procedural barriers that SB840 faces, although it doesn’t match SB840’s scope.
For employer-based coverage:
* More Available: A minimum employer contribution toward health coverage would encourage employers to make health benefits more available. So would the new, affordable option for employers of paying a fee to a statewide purchasing pool, which would then make coverage available to all the employer’s workers.
* More Affordable: The bill does place a limit on the share of premiums for workers under 300% of the federal poverty level to 5% of income. For those who qualify for public programs, they may be able to benefit from “premium assistance” that would make their employer-based coverage more afffordable. And to the extent that any minimum employer contribution is close to the actual cost of care, that provides a floor from which workers can bargain up in terms of benefits.
* More Automatic: Employer-based coverage is already pretty automatic for workers, and those workers in the statewide purchasing pool may have the additional benefit of having their coverage be portable if they shift to other employers also paying into the pool.
For public programs:
* More Available: The proposal would greatly expand coverage to low-income children and their parents, up to 300% of the federal poverty level. We would have a commitment to finally cover all children, and make coverage much more available for low-income adults, particularly parents.
* More Affordable: For those newly eligible for Medi-Cal or Healthy Families, they would get an affordable product, providing more affordable coverage than anything provided privately. For those is subsidized care above the poverty level, there still would be limits on premiums and cost-sharing.
* More Automatic: In a major step, the proposal would eliminate the asset tests (which prevented people from having any savings), and effectively scrap the depravation test, and remove semi-annual status reports, all of which were significant adminsitrative barrier to getting on coverage and staying on.
For the individual market:
* More available: The companion proposal, AB2, would limit insurers’ ability to deny coverage because of pre-existing conditions, so those with relatively minor ailments would now be able to get coverage. That 3-5% of the market that would be denied would then have access to an expanded high-risk pool with an improved benefit than what is now available under MRMIP.
* More affordable: While coverage won’t be affordable, the proposal would require employers to offer Section 125 plans so that employed Californians could pay their premiums using pre-tax dollars, providing savings at 15-40%.
* More automatic: The proposal attempts to place coverage in basic tiers for better comparison’s sake, so the confusion in the individual market is not although it still won’t be easy to buy coverage, and affordable packages are not expected.
AB8 doesn’t remove all these barriers–there would still be issues, and we have sought amendments to go further, especially on affordability. But the framework does, overall, reduce the barriers that impede consumers getting the coverage they want and need.