#Health4All Bill SB1005 Passes Senate Health Committee (And Other Legislative Updates)

HEALTH ACCESS ALERT: Thursday, May 1, 2014


*        On deadline week, with hundreds rallying and in support, Senate Health Committee passes #Health4All bill SB1005 to extend ACA-level help to afford coverage through state-only Medi-Cal and a “mirror marketplace” to all Californians, regardless of immigration status.

*        In last two weeks, key bills pass health committees for more industry oversight, including ones sponsored by Health Access California to help consumers once they get coverage, with continuity of care (SB1100), network adequacy and timely access to doctors and specialists (SB964), prescription drug cost sharing (AB1917), avoiding junk coverage (AB2088), and more. These measures continue to face insurer opposition.

        Several bills to undermine Covered California and the Affordable Care Act failed to proceed in policy committee, and other measures were amended to remove opposition from consumer groups. All committee actions have been detailed on the Health Access Blog.

*          Next Steps: Bills passed in Assembly and Senate Health Committee now go to Appropriations Committees where fiscal issues will be considered. If passed in Appropriations, bills will need to pass full floor vote in “house of origin” by May 30th.

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Yesterday, the Senate Health Committee, chaired by Senator Dr. Ed Hernandez, passed by a 6-1 vote a bill to extend coverage to all Californians, regardless of immigration status. The measure, SB1005, authored by Senator Ricardo Lara, would provide similar help to afford coverage as the Affordable Care Act (ACA) to those excluded from the federal law, through state-only Medi-Cal and a mirror marketplace parallel to Covered California.The bill was one of several that passed yesterday in Senate Health Committee, and on Tuesday in Assembly Health Committee, in the deadline week where bills needs to pass their first policy committee in order to proceed for the year. Several other bills of interest to consumer, community, and health organizations, to provide more oversight to insurers and the health industry, and further implement and improve the ACA, passed over the last few weeks in advance of that deadline, as detailed on the Health Access Blog. SB1005(Lara) and these other bills now head to Appropriations Committee. If passed there, they then will have to pass their first floor vote in their “house of origin” (the Senate for SB1005) by May 30th.

The bill hearing for SB1005(Lara) was the culmination of a series of significant grassroots activity and enthusiasm over the last several weeks, from press conferences and forums around the state, to a “CAR-E-van” that drove from San Diego and Los Angeles to Fresno and Sacramento over the past few days, with town halls and “cafe con leche” forums of undocumented Californians telling their stories of living uninsured without access to basic health care. A rally yesterday morning featured Senator Lara, and bill co-authors Assemblymen Pan and Bonta and Senator Mitchell, speaking to hundreds of SB1005 supporters with #Health4All t-shirts and signs. At the rally and the hearing, a diverse set of speakers told about the problems of families who are both undocumented and uninsured, and described the benefits of county safety-net coverage programs that provide help regardless of immigration status, like Healthy San Francisco and Healthy Way LA.

In the committee, as detailed on Twitter @HealthAccess using the hashtag #Health4All, Senator Lara and supporters made the case for extending coverage as “the right thing to do” for these families under the belief that health care is a right, but that it was more responsible to provide primary and preventive care, not just episodic and emergency room care. Health Committee member Senator Monning, who asked to be added as a co-author, noted that the major industries in his district and statewide, agriculture and tourism/hospitality, relied on an immigrant workforce, and Senator Lara agreed that a population that was crucial to California’s community and economy should be included in our health system as well.

Both Senator Monning and Chairman Hernandez pointed out that this committee was the venue to review the policy, and that the challenge of funding the proposal would be discussed in Senate Appropriations Committee; While Senator Lara said the numbers were being crunched with help from academics at the University of California, he pointed out the signficant money already spent on existing emergency and safety-net care for very limited services for the uninsured, and so a modest investment could provide fuller coverage more effectively and efficiently, with significant offset of savings.

Finally, both Senator Lara and Senator Hernandez pointedly brought up the lack of action by Congress on immigration reform to resolve this issue. Senator Lara referred to the immigrant rights victories in California last year on driver’s licenses and other issues, saying “once again California can lead where Washington has failed,” and Senator Hernandez indicating that this bill “could be a signal for the nation” as a key step to include immigrants.

The room was packed with supporters, and dozens of diverse organizations testified in support. No opposition testified. A vote took place after further discussion on the policy of the bill, which creates a state-only Medi-Cal program for those who are barred from Medi-Cal by reason of immigration status, covering kids up to 266%FPL and adults up to 138%FPL through state-only Medi-Cal. It also creates a parallel Exchange or “mirror marketplace,” governed by the same board as Covered California, that would provide immigrants with the same coverage options and subsidies. The bill got a 6-1 vote, with all the Democrats present voting in support, and GOP Senator Morrell voting in opposition. GOP Senator Nielsen did not vote.

NETWORK ADEQUACY: Another bill passed yesterday in Senate Health Committee was SB964 (Ed Hernandez), to require the Department of Managed Health Care (DMHC) to conduct surveys of health plans for timely access and network adequacy to be done more frequently, with specific emphasis on access to care for those in Medi-Cal managed care and Covered California plans. Sponsored by Health Access California, support testimony also came from Western Center on Law and Poverty, CPCA, SEIU, American Cancer Society Action Network, California Medical Association, March of Dimes, Children Now and other children, consumer, and provider organizations. Insurers testified in opposition about the administrative burden, but the bill passed the committee 5-1.

OTHER BILLS: Other legislation passed that would provide additional consumer protections for patients over the last few weeks, in previous legislative hearings in April that were recounted in detail on the Health Access Blog, which is updated regularly.

For example, on Tuesday, Assembly Health Committee passed AB1917 (Gordon) which spreads out the cost of expensive medications over the course of a prescription, to better help those with HIV/AIDS, cancer, MS, and other diseases manage out-of-pocket expenses. 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 this means that high-priced drugs, perhaps on a fourth tier that involves 20% co-insurance, won’t burden patients all at once.

Other bills sponsored by Health Access California that passed Health Committees in April included AB2088 (Roger Hernandez), which helps prevent consumers from only having junk insurance by restricting limited benefit plans to be supplemental to comprehensive employer-based coverage, extending a current consumer protection in the individual and small group markets into the large group market; and SB1100 (Ed Hernandez) to extend continuity of care protections for consumers who change their individual coverage—something that was not possible for many until the ACA. All these measures have strong consumer and labor support but continue to face insurer opposition.

Among other bills of interest to consumer advocates are measures to increase transparency with health care costs, such as AB1558 (Roger Hernandez) to provide claims data to the University of California so it can do studies on cost and quality, and SB1182 (Leno) to implement large group rate review for rate increases in excess of 5%. It also provides claims data or other detailed data to large purchasers.

Also getting significant attention in the legislative and budget process (like SB1005) is the issue of Medi-Cal rates. AB1805 (Skinner/Pan) would restore the remaining 10% reimbursement rate cuts to fee-for service Medi-Cal providers, a cut made in 2009-10 that was delayed by legal actions but is just being implemented this year, at the same time we are expanding Medicaid under the ACA. At a time of surplus, it would be less than $250 million to cancel this cut that was made in the worst moments of California budget crisis. A companion measure, AB1759 (Pan/Skinner), would extend the temporary increase in primary care rates that the Affordable Care Act began in 2013.

Not all legislation passed the first policy committee. Of note, several bills that may have undermined Covered California and/or the Affordable Care Act were defeated, or in some cases amendments were taken that removed opposition of consumer groups and health reform supporters. Health Access and other groups will continue to be vigilant about such ongoing attempts by industry or the law’s opponents, while continuing to support bills that implement and improve the law.

Those who wish to support SB1005 and other bills that are moving forward should send letters of support to the Assembly and Senate Appropriations Committees.