Heading toward the final hurdles…

Monday, July 26, 2010


* Many Bills Heading to Appropriations Committee: Last Hurdle Before Final Floor Votes
* Multiple Bills Would Implement & Improve Federal Health Reform in California
* At Stake Are New Consumer Protections; New Federal Funds; New Rules for Insurers

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Key health consumer protection bills in the California legislature, including several that would implement and improve the federal health reform law passed earlier this year, are heading into their final month of consideration before final floor votes.

Several are being heard next week in Assembly and Senate Appropriations Commitees, which are one of the last legislative hurdles before the final push to pass measures out of the Legislature before the end-of-August deadline. If bills are passed, the Governor has the month of September to either sign or veto the measures.

At stake are bills that would draw down new federal funds, from specific grants for consumer assistance, rate review, and community transformation, to a new Medicaid waiver that is hoped to bring down an additional $2 billion into our beleaguered health care system and safety-net. Other measures would institute new consumer protections and new rules and oversight over insurers.

BELOW is a description of some of the key bills pending. The Health Access website has a bill list of legislation related to implementing and improving health reform, as well as a broader list of bills of interest to health care consumers.

Relevant bills that are up in Senate Appropriations Committee on Monday, August 2nd, at 10:00am. Organizational support letters on these measures are due today, Monday, July 26:
* AB 342 (Perez) Waiver
* AB 591 (De La Torre) Premium Increase Moratorium
* AB 1503 (Lieu) Emergency Physician Overcharging
* AB 1602 (Perez) Exchange
* AB 2110 (De La Torre) Premium Grace Periods
* AB 2244 (Feuer) Kids with Preexisting Conditions
* AB 2345 (De La Torre) Preventive Services
* AB 2470 (De La Torre) Rescission
* AB 2450 (De La Torre) Post Claims Underwriting
* AB 2787 (Monning) Ombudsperson
(view full agenda here)

Several bills are also up in Assembly Appropriations Committee on Wednesday, August 4th, at 9:00am, with organizational support letters due later this week:
* SB 810 (Leno) Single Payer
* SB 900 (Alquist) Exchange
* SB 1088 (Price) Dependent Coverage
* SB 1163 (Leno) Premium Sunshine
(view full agenda here)

Among the bills up next week is SB810(Leno), a longstanding bill to establish a universal, single-payer health care system. While Governor Schwarzenegger has vowed to veto the measure (and the financing requires a 2/3 legislative vote), supporters has pressed on in order to continue to present, refine, and organize for the vision of a truly universal health care system.

Many of the other bills seek to fulfill the promise of the new federal law passed earlier this year, including the following measures:

** Creating a Consumer-Friendly & Transparent Individual Insurance Market & Exchange

* AB 1602 (Perez) & SB 900 (Alquist/Steinberg) CALIFORNIA HEALTH BENEFITS EXCHANGE: Would establish the California Health Benefits Exchange, which would be a main way for individuals and small businesses to buy coverage and get federal affordability subsidies that will be available starting in 2014. The bills set up governance for this exchange, and allow it to use its bargaining power to negotiate for better prices and values for consumers in the exchange.

** Setting Minimum Standards

* SB 890 (Alquist/Steinberg) TRANSITIONING TO A MORE TRANSPARENT & STANDARDIZED MARKET: Standardizes and simplifies the individual insurance market, so that consumers can understand their coverage choices, make apples-to-apples comparisons, and have the security that coverage does not have hidden loopholes, or lifetime and/or annual caps on coverage. Sets standard of basic health care services for products at both the Department of Insurance as well as the Department of Managed Health Care products.

* AB 1825 (De La Torre) ENSURING MATERNITY CARE: Would require most health plans to cover maternity services.

* AB 1600 (Beall) REQUIRING MENTAL HEALTH PARITY: Would require most health plans to provide coverage for the diagnosis and treatment of a mental illness.

** Federal Medicaid Waiver

* AB 342 (Perez) & SB 208 (Steinberg) MEDI-CAL WAIVER: The state’s 1115 Medicaid Waiver would draw down up to $2 billion in federal funding to expand coverage to new medically indigent populations. The waiver would also move seniors and people with disabilities to Medi-Cal managed Care. The waiver is intended as a bridge between the existing Medi-Cal program and the full access expansion that will happen in 2014 as a result of federal reform.

** Providing Access for Those with Pre-Existing Conditions

* AB 2244 (Feuer) ACCESS AND AFFORDABILITY FOR CHILDREN WITH PRE-EXISTING CONDITIONS: Requires guaranteed issue, eliminates all pre-existing condition exclusions, and limits premium increases based on health status, phasing in modified community rating for children under age 19 in the individual market. Sponsored by Health Access California.

* AB 2470 (De La Torre) REGULATING RESCISSIONS AND MEDICAL UNDERWRITING: Establish standard information and health history questions used by health insurers on application forms, and requires insurers to complete medical underwriting and review for accuracy before issuing an individual a health plan contract or policy.

* AB 2540 (De La Torre) POSTCLAIMS UNDERWRITING: Outlaws and enacts a fine for rescinding, canceling, or limiting of a policy or certificate due to the insurer’s failure to complete medical underwriting before issuing the policy or certificate or after a claim has been filed.

*** Regulating Insurer Rates

* AB 2578 (Jones) REQUIRING APPROVAL FOR RATE HIKES: Would require approval by the Department of Managed Health Care or the Department of Insurance of an increase in the amount of premium, co-payment, coinsurance, deductible, or other charges under a health plan.

* SB 1163 (Leno) SUNSHINE ON RATES: Would allow California to draw down new federal funds to institute rate review, to require insurers to disclose their justifications for rate increases.

* AB 591 (De La Torre) RATE MORATORIUM: Would (1) impose a 90-day moratorium on rate increases above average increases in the medical care consumer price index; (2) allow such increases if plans apply to DMHC or CDI to justify such increases; and (3) prohibit insurers from raising rates more than once per 12-month period.

* AB 2042 (Feuer) PROHIBITING MID-YEAR RATE HIKES: Insurers and HMOs cannot change or increase premiums, cost sharing, or benefits more often than once a year. Sponsored by Health Access California.

* AB 2110 (De La Torre) PROVIDING PREMIUM GRACE PERIODS: Would extend the grace period for premium payments from 10 or 31 days up to 50 days for most plans regulated by the Department of Insurance. Sponsored by Health Access California.

** Prevention

* AB 2287 (Monning) PREVENTION & WELLNESS: Would require the state to apply for community transformation grants to support prevention. Federal health reform provides for community transformation grants, a major element of wellness and prevention. These are grants for evidence-based, community prevention activities to reduce chronic disease rates and address health disparities.

* AB 2345 (De La Torre) COVERING PREVENTIVE SERVICES: Requires insurers to eliminate cost-sharing for some preventive services such as pap smears, mammograms, other cancer screenings, and immunizations; continues to permit co-pays and deductibles for managing asthma, diabetes, heart disease, and other chronic conditions.

** Additional Consumer Protections Under Reform

* SB 56 (Alquist) FACILITATING A PUBLIC HEALTH INSURANCE OPTION: Would authorize county-organized health plans and other health benefits programs to form joint ventures in order to create integrated networks of public health plans that pool risk and share networks, subject to the requirements of the Knox-Keene Act.

* SB 1088 (Price) ALLOWING YOUNG ADULTS TO STAY ON THEIR PARENTS’ COVERAGE: Would require group health, dental, and vision plans to allow dependent children to continue on their parents’ coverage through age 26.

* AB 2787 (Monning) FEDERAL GRANTS FOR STATE OMBUDSPERSON PROGRAMS: Establishes the Office of the California Health Ombudsman to educate consumers on their rights and responsibilities with respect to health care coverage, assist with enrollment in health care coverage, resolve problems in obtaining specified premium tax credits, etc.

* AB 1503 (Lieu) EMERGENCY ROOM PHYSICIAN FAIR PRICING: Would limit the amount that emergency room physicians and surgeons can charge an uninsured or underinsured patient with income below 350% of the federal poverty level. Sponsored by Health Access California.

* AB 542 (Feuer) NO PAY FOR NEVER EVENTS: Creates a process for ending Medi-Cal payments for never events (events that should never happen, such as surgery on the wrong body part), and requires insurers to stop paying for never events.

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