Medi-Cal Reforms, Fair Pricing Bill Advances

Wednesday, April 21st, 2009


* Bipartisan Vote to Ensure Fair Pricing by Emergency Room Doctors
* Process Begins on Renegotiating California’s Hospital Financing Waiver
* Other Medi-Cal Changes Also Pass Committee

More Updates on the Health Access WeBlog: Health Reform Hearings in the House; The Timetable for Federal Reform; Gender Discrimination; Honoring Frank Russo; The Packaging of Prop 1A; Married for Health Coverage?

In a hearing lasting over four hours, the Assembly Health Committee, chaired by Assemblyman Dave Jones (D-Sacramento), considered several bills that would impact California health care consumers. Some of the highlights include:

Self-Pay Patients To Get Help on ER Doctor Bills

AB 1503, Lieu (D) would require emergency room physicians to charge rates to lower-income patients who do not have health insurance. Currently, uninsured individuals treated in emergency rooms are frequently charged three to four times more what insurers pay for exactly the same service. The measure specifies that ER doctors would have to offer eligible patients rates that are no higher than those paid by Medicare, Medi-Cal or similar government programs. Physicians also would have to offer payment plans, rather than submit unpaid bills to collection agencies.

The measure prohibits wage garnishments or liens, and prohibits the forced sale of a patient’s home as a means of collecting the debt. These consumer protections already apply to hospital billing under AB774(Chan) of 2006, and in this bill would be extended to individual ER physician billing. As of 2007, about 6.5 million Californians were without health insurance. Research pinpoints medical debt as the leading cause of personal bankruptcy in the United States . The bill got support from Health Access California, ACORN, Western Center for Law and Poverty, Congress of California Seniors, Jericho, and others. The bill won unanimous bipartisan support in committee, and AB 1503 advances to the Assembly Appropriations Committee.

Key Medi-Cal Reforms Pass

Hospital Financing Waiver Process Starts: AB 342, Bass (D) and Jones (D), a companion bill to its Senate counterpart, SB 208 (Steinberg), lays the groundwork for the state to negotiate a new Medicaid waiver from the federal government, a crucial component of financing for the state’s public and safety-net hospitals, and for the health system as a whole. Specifically, the bill gives the go-ahead for the state to draft a comprehensive waiver from federal Medicaid rules, with an eye toward preserving and strengthening safety-net providers and maximizing federal funds. The measure is not fully detailed, but sets the stage for negotiations with stakeholders, many of whom testified with their interests and concerns as part of the process in developing this plan. AB 342 overwhelmingly won passage to the Assembly Appropriations Committee.

Fewer Payment Hassles for Medi-Cal Enrollees: AB 1142, Price (D), would reduce unnecessary headaches for Medi-Cal beneficiaries by requiring hospitals and providers to make an extra effort to bill the program, instead of unnecessarily sending the bill to the patient. The bill calls for a series of actions following patient care to ensure Medi-Cal consumers are not wrongfully pursued for debt that the program would cover. It would require hospitals to share eligibility status with hospital-based providers, ambulance services and other appropriate professionals. Fines up to three times the amount of the Medi-Cal payment would result if the provider has proof of Medi-Cal eligibility but pursues collection from the patient instead, resulting in a negative credit report. AB 1142 got support from Western Center on Law and Poverty, and children’s, labor, low-income, and consumer organizations, including Health Access California. The bill advanced the Assembly Appropriations Committee on a strict party-line vote, with Republicans voting “nay.”

Extended Medi-Cal Coverage for Disabled Workers: AB 1269, Brownley (D), would make health coverage more affordable for many working people who are disabled. Specifically, it would extend eligibility for Medi-Cal under the California Working Disabled Program for 26 weeks effective March 1, 2010. Groups representing people with disabilities, health providers, and consumers, including Health Access California, supported AB 1269. The bill advanced, with voting along party lines, to the Assembly Appropriations Committee.

Less Bureaucracy, Duplication for Medi-Cal Enrollees: AB 963, Ammiano (D), would lessen paperwork for low-income individuals and families who apply for food stamps, also streamlining their applications for Medi-Cal eligibility. It would require stakeholder groups, the Department of Social Services, counties and the Statewide Automated Welfare System to coordinate efforts in a collaboration to update data sharing, technology and administrative procedures to ensure continued health coverage for eligible people whose status in other programs changes. The measure, which advanced to the Assembly Appropriations Committee, prohibits the Department of Health Care Services from imposing duplicative and burdensome paperwork requirements. Health Access California is in support of AB 963.

Some Bills Stall

The committee passed most bills it considered, with the exception of a ten percent fee on alcohol to fund alcohol and drug programs, and a measure to require disclosure of employer’s claims data. AB 562, Cook (D), failed to pass when lawmakers’ concerns about ensuring employee privacy trumped the bill author’s call for greater transparency. The stated purpose of the bill was to give mid-sized small business employers more information about where their health care dollars are going while they shop for policies. Insurance underwriters testifying in favor of the measure said business owners who pay a portion of their workers’ premiums should be able to discern what costs lie behind their investment when negotiating with insurers. The bill was opposed by both health insurers and privacy advocates, and some Health Committee members expressed concern that too close a look at the health care costs would expose employees to discrimination, termination or simply compromise their privacy. The bill failed to advance out of committee, and is up for reconsideration. (Health Access California did not take a position on the measure.)

Given the length of the hearing, some bills were “put over” to be considered during next week’s hearing. All bills need to pass policy committees by April 30. Health Access will continue to provide updates on actions taken in the Legislature. For a broader list of interest to health advocates and Health Access California , check out the bill list on our website.

For more reports on legislation, visit the Health Access WeBlog, at

Health Access California promotes quality, affordable health care for all Californians.
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