Key Consumer Protections Bills Move Forward

Earlier today Senate Health Committee passed several key bills benefiting health care consumers, including two sponsored by Health Access California: AB 339 (Gordon), dealing with high cost specialty medications and AB 533 (Bonta), which halts surprise bills from out-of-network providers.

Both bills go beyond Affordable Care Act to provide improved patient protections—ensuring that the cost sharing protections apply to consumers living with chronic conditions (AB 339), and taking consumers out of the middle of disputes between health plans and providers about charges for out-of-network care.

AB339 (Gordon) presented today by Assembly Member Rob Bonta, would require insurers to cover medically necessary prescription drugs and limit cost-sharing on specialty drugs and other needed medications. This bill passed out of Senate Health on a vote of 7-2.

“Californians should not have to face discriminatory cost-sharing just because of their specific diagnosis, said Sawait Hezchias-Seyoum of Health Access, sponsor of AB 339. According to a recent Kaiser Foundation study, the average consumer has only $2,300 in liquid assets- under the current policy, a consumer with a chronic condition can burn through that in one month of co-pays alone. While some drug cost-sharing would still be high, this bill would make those costs more manageable. Since Covered California recently adopted many of the protections included in AB 339, including monthly caps on drug costs, the bill has new momentum to extend such patient protections throughout the state.

To the California Association of Health Plans and other opponents’ argument that AB 339 does not address the prohibitive and rising costs of specialty drugs, Hezchias-Seyyoum stated that it was the insurers who were best equipped to negotiate prices, not individual consumers—and AB 339 simply gets consumers out of middle of this “clash of the titans.”

The bill’s opponents argued for the need to address the underlying high costs of specialty medications—but the way to tackle this is through transparency initiatives like AB 463 (Chiu) Pharmaceutical Cost Transparency Act, which will return in January 2016 as a two-year bill.

AB533 (Bonta), which would put an end to the “surprise bills” patients encounter when out-of-network providers administer care within in-network facilities, passed on a 6-2 vote.  Surprise bills can leave consumers with as much as $12,000 in medical debt, says Betsy Imholz of Consumers Union. The bill stops this practice, and also requires health plans to pay non-contracting providers the average contracted rate paid for the same services in a similar geographic region, says Tam Ma of Health Access, the bill’s sponsor. Recent amendments to the bill address a practical problem that non-contracting providers have when they disagree with what the plan pays them. Right now, these disputes over low-dollar but high volume claims are litigated in court, explained Ma. AB 533 creates a mandatory and binding independent dispute resolution process to resolve these claims—a fair solution to the thorny issues raised by the opposition, says bill author Rob Bonta. Representing the opposition were state specialty medical societies for anesthesiologists, orthopedic surgeons, radiologists—incidentally some of the highest paid medical specialties.

To Senator Richard Roth fine question about whether patients are or perhaps should be given an opportunity to learn whether members of their care team are in or out of network, the anesthesiologists’ spokesperson said this typically happens in the pre-op meeting (before the patient goes ‘under the knife’)— that 1 in 4 consumers  have dealt with a surprise medical bill, as found in a recent Consumers Union survey, suggests this is far from the current practice.

“On AB 533 I’m going to lean with the consumers,” said Sen. Hernandez, in part “because the consumer is now required to purchase health insurance—and with that purchase they should have some confidence about who is in-network.  “We should not put the onus on patient to figure out everyone in the care team,” added Hernandez.

Another bill moving forward was AB 1102 (Santiago), which Health Care Coverage: Medi-Cal Access Program, Disclosures, supported by Western Center on Law and Poverty, Health Access, SEIU, March of Dimes, and others, would require that information on MRMIP (Major Risk Medical Insurance Program) coverage options be provided to women who become pregnant, Even after full implementation of the Affordable Care Act, this program has been preserved, explained Beth Capell for Health Access, as a safety net, for example for those who miss open enrollment. This bill passed 8-0.