Key patient protections on their way to the Governor’s desk…

Wednesday, August 25, 2010


* CA State Senate Passes Efforts that Implement and Improve Health Reform, Including:
* AB1825(De La Torre), to Phase-In Maternity Coverage as a Basic Benefit
* AB1600 (Beall), to Require Mental Health Parity in Health Coverage
* AB2244 (Feuer), to Limit Premiums for Children with Pre-existing Conditions
* SB56 (Alquist), to Foster New Public Health Insurance Options
* SB1088 (Price), to Allow Young Adults up to Age 26 To Stay on Parental Coverage

* CA Assembly Passes and Sends to Governor Other Key Consumer Protections, Including:
* AB1602 (Perez), to Create a New Health Insurance Exchange
* AB1503 (Lieu), to Prevent Emergency Room Doctor Overcharges for the Uninsured
* AB542(Feuer), to Prevent Medi-Cal Payment for “Never Event” Medical Errors
* AB2042(Feuer),to Limit Rate Hikes and Changes to Once a Year

* Rate Regulation, AB2578(Jones), and Other Key Bills Up Later This Week

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Earlier today, the California Legislature voted to pass several new patient protection bills, measures that would implement and improve the passage of federal health reform. Here are some of the bills that were considered:

* LIMITING SURCHARGES FOR CHILDREN WITH PRE-EXISTING CONDITIONS: AB 2244 (Feuer) implements the federal prohibition on denying coverage to children with pre-existing conditions, and limits the amount that insurers can charge to cover those children.

The federal health law took an important first step by prohibiting insurers from denying coverage to children with pre-existing conditions, starting this September. AB2244, sponsored by Health Access California, takes another step in making the reform real, by also limiting how much insurers can charge children with pre-existing conditions. Federal law will prohibit such premium differences in 2014, but this bill phases in this help with affordability sooner, and provides a smoother glide path for California’s market to transition.

Proponents say the bill would save tens of millions in the state budget, giving families the opportunity to buy private insurance rather than having them fall onto public health coverage programs, like Medi-Cal, Healthy Families, and CCS (California Children’s Services for children with disabilities). The California State Senate passed AB2244.

* EMERGENCY ROOM DOCTOR CHARGES: AB1503 (Lieu) provides consumer protections to ensure uninsured and underinsured patients are charged fair prices for emergency physician services. The bill would require physicians who provide emergency medical services in hospitals to implement a discount payment policy, including a limited rate, for financially qualified patients. The bill would also place limits on the collections activities of these physicians.

Since emergency room patients are not in a position to shop around or bargain for the best price, AB1503, sponsored by Health Access California, puts in place some protections against unfair bills. It provides first-in-the-nation consumer protections that ensure that self-pay emergency room patients pay similarly to what is billed to other payers and insurers, and not multiple times more, as has sometimes been the case.

California passed groundbreaking consumer protections in 2006 against hospital overcharging, where hospitals charged uninsured patients 3-4 times what insurers and government programs paid for exactly the same service. AB 1503 provides similar notice and protections to the emergency room doctor bill that often accompanies the hospital bill. Consumer advocates appreciated emergency room doctors working to reach an equitable fair pricing agreement. The measure passed the Senate yesterday, the Assembly today on a unanimous vote, and is heading to the Governor’s desk.

* MATERNITY COVERAGE: AB 1825 (De La Torre) phases in a requirement for all health insurance plans to cover maternity care.

This measure provides equity for women trying to buy coverage, saves the state money by preventing women from having to rely on public programs for maternity benefits, and most importantly provides the public health benefit of getting babies the prenatal and early care coverage they need to live healthy and productive lives. AB1825 passed the California State Senate and goes back to the Assembly for concurrence.

* MENTAL HEALTH PARITY: AB1600 (Beall), which requires mental health parity in private coverage, also passed the California State Senate and goes to the Assembly for concurrence. Presented in the Senate by GOP Senator Roy Ashburn, the bill ensures that patients should be covered for mental health similarly to how they are covered for physical health.

* NEW HEALTH INSURANCE EXCHANGE: AB1602 (Perez) (along with SB900(Alquist)) sets up the a new health insurance exchange, where consumers can easily compare plans, get coverage, and access federal subsidies to make coverage more affordable. Like large employers do now, the exchange would bargain with health insurers for the best price and value, for potentially over 4 million Californians. AB1602 (Perez) passed the Assembly, and with SB900 (Alquist) which passed the Legislature yesterday, is now heading to the Governor’s desk.

* LIMITING RATE HIKES TO ONCE A YEAR: AB2042 (Feuer) would get health insurers to limit plans from raising rates or changing premiums, cost-sharing, or benefits to once a year. This is intended to provide stability to patients who want to know their premiums don’t change mid-year, messing with their annual budget. AB2042, sponsored by Health Access California, passed the Assembly, and heads to the Governor.

* MEDICAL ERRORS: AB542 (Feuer) would set up a process so that Medi-Cal would no longer pay for “never events,” major medical errors that should not “never” happen. This bill is intended to encourage providers to set up systems that prevent such errors before they occur.

* YOUNG ADULT COVERAGE: SB1088 (Price) would implement the federal health law that allows young adults up to age 26 to stay on their parents’ group coverage. The bill passed the Senate today and heads to the Governor’s desk.

* JOINT VENTURES AND PUBLIC OPTIONS: SB56 (Alquist) would foster new public health insurance options by allowing county-based Medicaid managed health care plans (such as Alameda Alliance for Health, LA Care, and San Francisco Health Plan) to enter into joint ventures, offer broader provider networks, and be viable choices in the marketplace.

* PREVENTATIVE CARE: AB 2345 (De La Torre) requires insurers to eliminate cost-sharing for some preventive services such as pap smears, mammograms, other cancer screenings, and immunizations. The measure passed the Senate floor yesterday.

KEY VOTES COMING UP: Several other consumer protections are still pending in this final week of legislative action. Of particular note:

In Assembly Health Committee tomorrow for final amendments:
* SB890(Alquist) to make the individual insurance market more transparent and secure, classifying health plans in tiers (Platinum, Gold, Silver, Bronze) to allow consumers better ability to make apples-to-apples comparisons, and implement health reform with regard to prohibiting annual or lifetime limits on coverage.
* SB1163(Leno) to require insurers to provide greater transparency about their rates, their methodology, and their proof of actuarial soundness.

In the Senate:
* AB2578(Jones), which would require insurers to justify their rates and submit rate hikes for approval to the Department of Insurance and Department of Managed Health Care. Click here for the HCAN-CA ALERT on this important rate regulation measure.
* AB2470 (De La Torre), which would implement health reform by eliminating rescissions, so patients don’t have their coverage yanked away at the time when they most need it.

The deadline to pass measures is the end of August, and then the Governor will have the month of September to sign or veto measures.

For more information related to federal health reform, read the new report, “Health Reform Three-Month Status Report: Californians Begin To See the Benefit, Much More Work To Do.” which is available on the Health Access website.

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

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