Assembly Health Discusses Wellness and Essential Benefits

California’s Assembly Health Committee began their meeting today with a special hearing on Health and Wellness Programs, which we tweeted extensively at

Wellness programs are a timely topic as the Affordable Care Act provides opportunities for augmenting programs to go beyond simply providing access to health coverage, but to take measures to improve health and wellness. The Committee heard from a panel of stakeholders who spoke about their experiences with health and wellness programs. Panelists included representatives from the American Diabetes Association, the American Heart Association, the American Cancer Society, the California Pan Ethnic Health Network, Small Business Majority, SeeChange Health Insurance, and the California Association of Health Plans.

Virtually all the witnesses spoke of the need to encourage wellness and prevention, including at the worksite, for both better health and to help lower costs. But concerns were raised about programs that were linked to a worker or patients’ health premium or cost-sharing, perhaps permitting a form of “backdoor underwriting.” Consumer advocates have also long held concerns over health equity issues –whether such policies would benefit those who are healthy that already won the “genetic lottery” rather than those who inherited diseases like diabetes or a heart condition. Some testified that incentives that ask individuals to change behavior can be discriminatory when certain populations have unequal opportunities to do so. For example, low-income communities or communities of color may live in places where it is difficult or unsafe to exercise, or where there is limited access to healthy food. Additionally, insurers have, in the past, used premium or cost share related wellness programs to exclude individuals who need these programs the most. For example, charging higher premiums to diabetics discourages individuals with diabetes from choosing a particular health plan.

The panel and Committee members had a good discussion about the various types of health and wellness programs, and their varying effectiveness.

The Committee then began its regular business by considering AB1636 (Monning). Mr. Monning’s bill will create a committee to examine peer reviewed research in order to ensure that as the state moves forward with implementation of the wellness incentives allowed by the ACA, that we make sure we do it right and without unintended consequences. AB1636 (Monning) passed out of Committee with 12 votes.

Also considered was AB2152 (Eng) which strengthens disclosure and notice requirements for insurance products in order to make sure that individuals who are covered by insurance products (plans regulated by the Department of Insurance) have similar consumer protections as consumers insured under plans regulated by the Department of Managed Health Care. AB2152 (Eng) passed with 12 votes.

The Committee also considered AB1453 (Monning) related to Essential Health Benefits. One of the most important provisions of health reform, essential health benefits define the minimum requirements for all health plans in the small group and individual market, providing consumers with the assurance that all medically necessary care will be covered. The federal government asked states to choose an existing plan as a template, from a range of 10 options. The bill proposes the use of Kaiser’s Small Group insurance plan as the benchmark plan for essential health benefits. This is a comprehensive plan which includes the strongest consumer protections from the Knox-Keene Act. Though the insurance industry expressed some concerns with language, there was no formal opposition to the bill. AB1453 passed along party lines.

These three bills move on to Appropriations Committee. Stay tuned for tomorrow’s report from the Senate Health Committee.

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