Key Health Care Consumer Protections to Prevent Unfair Out-of-Pocket Costs Advance to Final Floor Votes

  • SB137 (Ed Hernandez), to require updated, standardized & accurate health plan provider network directories, passed out of Assembly Appropriations Committee.
  • AB533 (Bonta), to stop “surprise” billing from out-of-network doctorsAB339 (Gordon) to prevent unfair cost-sharing for specialty drugs, and AB1305 (Bonta) to limit out-of-pocket costs for individuals in family plans, passed out of Senate Appropriations Committee.
  • SB248 (Roger Hernández), a bill to prevent large employers from offering “junk insurance,” fixing an ACA loophole,  passed the full Assembly and is now heading to the Governor’s desk.
  • #Health4All Update: SB4 (Lara), to allow undocumented California to shop for health coverage in Covered California, seeking a Section 1332 federal waiver to remedy their exclusion in the ACA, also passed out of Assembly Appropriations.

Yesterday, the Appropriations Committees of the California Senate and Assembly met to decide the fate of hundreds of bills, including several designed to protect health care consumers.

Though the chief purpose of the Appropriations Committees review of bills on the “suspense” file is to evaluate the bills in terms of fiscal impact on the state budget, the outcome also reflects the results of delicate negotiations, finicky amendments and careful number crunching. Yesterday some bills were held, but many passed. Of the 309 Assembly bills considered in Senate Appropriations and 129 Senate bills considered in Assembly Appropriations, most will move on for final consideration on the floor by the September 11 deadline. The Governor would have until October 11 to sign or veto the bills.

For details on bills sponsored or supported by Health Access see our updated Bill Matrix

Health Care Consumer Bills Clear Major ‘Suspense Day’ Hurdle

While some health and other bills were held by the Appropriations Committees, which means they stalled for the year, most of the key consumer protection measures advanced. See the updated Bill Matrix on the Health Access website to track which bills were held, amended, or passed as is.

Following passage through the Appropriations Committees, the following Health Access-sponsored bills on limiting unfair out-of-pocket costs will move forward for full consideration on the Assembly and Senate Floors:

  • SB137 (Hernandez) would address the common insurance industry practice of posting inaccurate, out-of-date, and misleading provider directories. Consumers need accurate and updated directories to shop for plans, and once enrolled to know where to go for care without getting hit with a surprise out-of-network bill that could be hundreds of dollars more. The bill is co-sponsored by California Pan-Ethnic Health Network, Consumers Union, and Health Access California. (See separate SB137 fact sheet.)
  • AB339 (Gordon) would require insurers to cover medically necessary prescription drugs and limit cost-sharing on high cost specialty drugs and other needed medications. The bill ensures coverage for medically necessary prescription drugs; constrains placing most or all of the drugs to treat a condition on the highest cost tiers of a formulary; requires formularies to be based on clinical guidelines and peer-reviewed scientific evidence as well as drug costs; places monthly cap on specialty drug cost sharing; and more.  Drug costs would be capped at $250 per month for most coverage or $500 per month for bronze plans, far lower than the current limits of $6,600 for a single prescription. This bill would make those costs more manageable, preventing discriminatory benefit design. Since Covered California recently adopted many of these protections, including monthly caps on drug costs, the bill has new momentum to extend these patient protections throughout the state (see separate AB339 fact sheet).
  • AB533 (Bonta) would put an end to the “surprise bills” patients encounter when out-of-network providers provide care within in-network facilities. Patients unfairly get surprise medical bills from out-of-network doctors when they go to an in-network hospital, imaging center, or other facility. The bill would ensure that patients who do the right thing and stay in-network will not get charged extreme out-of-network out-of-pocket costs that imperil family finances. The bill is gaining momentum despite the opposition from some doctors’ groups (see separate AB533 fact sheet).
  • AB1305 (Bonta) would ensure that an individual in a family plan only has to pay up to the individual out-of-pocket maximum (around $6,600) rather than the family out-of-pocket maximum (over $13,200). This ensures individuals are not penalized with higher medical expenses just because they are part of a family plan (see separate AB 1305 fact sheet).
  • Another Health Access-sponsored bill, AB248 (Roger Hernández), to prevent unfair out-of-pocket costs, is further along in the legislative process. This bill, which would extend protections against “junk insurance” to those benefits offered by large employers, passed the full Assembly on a concurrence vote and is on its way to Governor Brown for a signature or veto.


Also passing Assembly Appropriations yesterday was SB4(Lara), a bill to allow all Californians to buy health coverage (using their own money) through Covered California, including undocumented immigrants who are currently excluded from using state-based exchanges under the Affordable Care Act. The bill would seek a waiver from the federal government, available through the ACA in 2017, to allow undocumented immigrants to use the same marketplace tools as everyone else. While the bill would not provide affordability subsidies (or otherwise use any federal funds, since exchanges like Covered California are now self-funded), it would allow Covered California to help families with mixed immigration status to get coverage and figure out coverage options for the entire family, even if some are subsidized and others not. The bill would remove not just an unjust symbol of exclusion but the practical enrollment barrier of undocumented Californians having to go outside of Covered California to a broker to sign up in the same plan as their family members.


Bills that passed the Appropriations Committees on Thursday will be voted on the Senate and Assembly Floor, as early as Monday. Bills that were not amended are likely to be voted on in quick order, while bills that were amended coming off suspense will be voted on once the amended version of the bills are in print. There may be further floor amendments for some of these bills. After the second house votes, the first house must concur in any amendments made in the second house: This often happens on the next day or even the same day. September 11th is the last day for any bill to be passed out of the Legislature. The Governor then has a month to sign or veto bills.


The Special Session on Public Health, which is happening concurrent with the regular session but under a slightly different timetable, is hearing a package of tobacco control bills aimed to reduce smoking and save lives. The following Senate tobacco control bills passed the full Senate today, including  bills to raise the smoking age to 21; regulate e-cigarettes as tobacco; increase licensing fees for selling tobacco; allow localities to raise tobacco taxes; and more.These bills have moved to the Assembly and are expected to be heard in the Assembly Public Health and Developmental Services Committee next week (Date TBD). The Assembly version of these bills passed the Assembly Public Health and Developmental Services Committee last week and will be heard in Assembly Finance next week (Date TBD).

Introduced earlier this week was the flagship legislation of the package, to raise the tobacco tax $2 a pack, ABx2 16 (Bonta/Thurmond) and its companion, SBx2 13 (Pan/Hernandez). Despite the hurdles of getting a 2/3 vote for any tax, there is considerable momentum for such an increase—especially since much of the revenue would go to improving access to care in Medi-Cal.

Since the last time California updated its tobacco tax in the 1990s, 48 states—all except Missouri, have raised theirs. California’s tobacco tax is now below average, falling to 35th in the nation this July when states like Kansas and Louisiana have raised theirs. A Field Poll this week showed that 67% of Californians support such a tobacco tax proposal (learn more here). Advocates are pushing for a vote in the next two weeks, before the legislators leave the Capitol after September 11.

 Contributors to this blog include Sawait Hezchias-Seyoum, Anthony Wright, and Judi Hilman.