Some basic questions…

The Senate Health Committee met today to discuss a number of bills of concern to health consumers.

SB703 (Hernandez) would create a Basic Health Plan as an alternative for individuals between 133% and 200% of the Federal Poverty Level as an alternative to participating in the Health Benefits Exchange in 2014. The bill would charge the Managed Risk Medical Insurance Board (MRMIB), which is currently tasked with administering the Healthy Families Program, and the 2 High Risk Pools, to run the basic health plan.

The concept is a simple one, and one that few can argue with: to take 95% of the federal money that would be used to provide tax credits and subsidies to these individuals if they participated in the Exchange, and use those dollars to create a better way to deliver health care to this population. It may be possible to use those resources, rather than simply subsidizing private coverage in the Exchange, to meet the three goals of: (1) provide richer benefits and better health care, (2) lower premium costs for participants, and (3) provide better provider reimbursements. But the devil is omnipresent in the details here.

THE MATH: The authors, proponents, and concerned advocates agree that this bill would not make sense if the numbers don’t add up. Cost projections are currently being calculated in order to see if it is possible to achieve the three goals with the money available.

THE BIGGER PICTURE: While the jury is out on whether the Basic Health Plan would be able to provide better and more cost effective care to the designated population, there are questions about its impact on other groups. It is believed that this group would be among the healthiest relative to others who would participate in the Exchange, and diverting them into a separate plan would be harmful to the risk mix of the Exchange by leaving it with a sicker population on average. Additionally, advocates wonder if a Basic Health Plan would diverting a quarter to one half of the Exchange’s potential customers and cripple the bargaining power that entity would have to negotiate for rates and benefits on behalf of consumers.

ENROLLMENT: This population is one with a great level of income volatility, and it is likely that participants’ eligibility status would change along with their income. Creating mechanisms for seamless transitions between this and any other public or private programs is also an important consideration.

MRMIB: Senator Hernandez stated that charging MRMIB with running the Basic Health Plan made sense because it was the only state agency currently equipped to do so, and that the Exchange does not yet exist. But advocates and other wonder if it makes more sense at the Exchange or elsewhere.

Health advocates testified not in support or in opposition but in raising these issues, and committed themselves to working with the Senate Committee chair to discuss ways in which a Basic Health Plan could be shaped to improve care for these low-income families and ensure that it is not counterproductive toward the goal of access to better health care for more people. The bill passed and moves out of Committee.

The Senate Health Committee considered several other bills including SB 408 (Hernandez) which closes a legal loophole and requires new owners of hospitals or other health care facilities to apply for licensure upon the change of ownership.

Stay tuned for more committee action next week!

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

Leave a Comment

%d bloggers like this: