Appropriations Committees Pass Key Health Bills

HEALTH ACCESS UPDATE: Thursday, August 14, 2014 


*        Important health bills advance, including ones sponsored by Health Access California, and head toward floor votes in final two weeks of legislative session.

*       Bills passed by Appropriations Committees today include those to help consumers once they get coverage, with ensuring network adequacy (SB964) and timely access to care (AB2253), avoiding junk coverage (AB2088), putting in place rate review (SB1182) for large employers, getting insurers to track out-of-pocket expenses (SB1176), limiting Medi-Cal estate recovery (SB1124), and accepting foundation money for Medi-Cal renewals (SB18) and more.

        Bills held and stalled for the year include two to create on all-payer claims databases, a bill on hospital community benefits, and a measure codifying Covered California privacy protections.

*        In other news, Health Access’ Beth Abbott appointed by Governor Brown to be director of the revamped Office of the Patient Advocate.


Today, the Appropriations Committee of both the California Senate and Assembly met, and decided the fate of hundreds of bills, including several to provide new consumer protections and oversight to benefit health care consumers.

Over 300 bills in the Senate and over 150 bills in the Assembly were “on suspense,” being evaluated in terms of their cost and fiscal impact, until today, where a portion of them were released, set to go to floor votes in the next two weeks. Bills must pass through final floor votes and the full Legislature by the end of August. If passed, the Governor would have the month of September to sign or veto.

Bills that passed Appropriations Committee today included key bills to ensure network adequacy and timely access to care: SB 964 (Ed Hernandez) would require DMHC to do annual reviews for timely access and network adequacy, separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California get timely access to necessary care. AB 2533 (Ammiano) would ensure timely access to necessary care at in-network cost-sharing.

SB 1176 (Steinberg) gives health plans and insurers the responsibility to track out of pocket costs–and reimbursing when patients hit the out-of-pocket maximum.

Another bill, AB 2088 (Hernandez) would extend consumer protections against “junk” insurance to large group market, banning large employers from offering limited benefit plans to their employees, unless the limited benefit plan was supplemental to comprehensive coverage.

Two important Medi-Cal bills also passed.SB 18 (Leno) would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance, and drawing down federal matching funds as well. SB 1124 (Hernandez) would limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death.

SOME BILLS HELD: afterNot all bill survived the Appropriations Committee process. Two bills, SB1322(Ed Hernandez) and AB1558(Roger Hernandez) to create versions of an all-payer claims database–to provide more cost transparency in our health system–were held. AB503(Wieckowski) on hospital community benefits was also held, as was SB974(Anderson) to codify Covered California’s privacy protections. These held bills, and others, are stalled for the year.


Many bills did make it through the Appropriations process, and consumers groups are mobilizing in support. These are some of the bills of interest to health care consumers pending for floor votes in the state legislature in the next two weeks:

Ø  Insurance Consumer Protections

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.


PRESCRIPTION DRUG COST SHARING: AB1917 (Gordon): would cap prescription drug co-pays at 1/12 of the annual out-of-pocket limit so that patients with HIV/AIDS, cancer, MS, and other diseases will not be forced to pay high upfront costs for their medication. Consumers would still have the annual out of pocket limit of no more than $6,350 for an individual or $12,700 for a family under the ACA, but the cost of any one drug can’t be more than 1/12 of the annual limit or $530 for a single month’s prescription rather than $6,350 as current law provides. Sponsored by Health Access California.


JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California law  allows the sale of “insurance” that provides limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for employers to avoid compliance with the intent of the ACA. Sponsored by Health Access California.


SB1176 (Steinberg) makes the health plan or insurer responsible for tracking out-of-pocket costs for in-network providers, and reimbursing the consumer when they exceed their out-of-pocket limit. SUPPORT.


AB 2533 (Ammiano) would seek to ensure timely access to necessary care at in-network cost sharing. SUPPORT.


SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013. SUPPORT.


SB20 (Ed Hernandez) modifies the individual market open enrollment period for the 2015 policy year to be November 15, 2014-February 15, 2015, so that it is consistent with the dates announced by the federal government exchange. SUPPORT.


SB1034 (Monning) would delete 60 day waiting period for California insurance. California law would not permit any waiting period as a result of a pre-existing condition. Federal law would permit employers to impose a waiting period of as much as 90 days for workers and dependents. SUPPORT.


Ø  Cost/Quality Transparency

SB1182 (Leno) would implement large group rate review for rate increases. It also provides claims data or other detailed data to large purchasers.  SUPPORT.


AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association. SUPPORT.


Ø  Hospital Oversight and Consumer Protections.

SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT.


SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses; allowing underinsured individuals with high health costs (over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers. SUPPORT.


Ø  Medi-Cal

SB18 (Leno/Hernandez)would have the state Department of Health Care Services accept foundations funds (currently offered by the California Endowment) and get federal matching funds to help provide assistance for Medi-Cal renewals. Sponsored by Health Access California and Western Center on Law and Poverty.


SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform. SUPPORT.


AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.


Ø  Prevention

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network. SUPPORT