Legislative Re-Cap: After the First Deadline…

Last Friday was the deadline for all policy committees in the California legislature to hear and report on all bills with fiscal implications–and the good news is that many key bills of interest to health care consumers have passed their first critical hearing. While some bills stalled (including almost all of those Health Access opposed but also a few that advocates supported), bills moving forward include limits and protections against unfair out-of-pocket costs; efforts at greater transparency on cost and quality in our health system; and an expansion of access to coverage for all regardless of immigration status. For details on each bill, see our weekly bill matrix

These bills still have a long path to final passage, including a June 5th deadline (only one month away!) to pass a full floor vote in the bill’s first legislative chamber, whether in the Assembly or Senate. Before then, most bills with fiscal implications go to the Appropriations Committee. In the Appropriations Committee, any bill costing over $150,000 is tagged as “on suspense,” meaning that that bill’s priority needs to be decided alongside other bills that cost money. The fate of bills “on suspense” will be decided near the end of May at the Appropriations Committee’s suspense hearing, and then they proceed for floor votes the week of June 1-5th. A handful of bills have passed both the policy and fiscal committees and are already on their way to the Assembly or Senate Floor for review.

#HEALTH4ALL; A top priority bill for Health Access and many of our partners, SB4(Lara) to expand coverage regardless of immigration status passed Senate Health Committee in April 7-0. Last Monday it was heard in Senate Appropriations Committee and placed, as expected, on suspense, awaiting a decision in late May along with many other bills. This bill, to expand Medi-Cal to all income-eligible Californians regardless of immigration status and allow undocumented Californians to buy insurance with their own money through Covered California, got support and powerful testimony from health, immigration, community, labor, and provider groups. Senators on both the Health and Appropriations Committee added their own affirmation to the bill, with many signing on as co-authors. Going forward, the biggest issue is the potential cost, and the new Appropriations analysis suggests the potential costs are a fraction of last year’s proposal–from $100-$300 million if the President’s executive action on immigration is upheld by the courts (thus covering a significant portion of uninsured immigrants). Health and immigration advocates are gearing up for a major push in late May for a potential Senate floor vote in early June.

OUT-OF-POCKET COSTS: All five Health Access-sponsored consumer protection bills to prevent unfair out-of-pocket costs have passed Health Committee…

  • Health Access sponsored legislation, AB533 (Bonta), which would prevent consumers from getting out-of-network bills when going to an in-network hospital or facility, passed out of the policy committee unanimously. Even when patients do the right thing by going to an in-network facility, they remain vulnerable to “surprise bills,” which can add up to hundreds if not thousands of dollars and put a family’s finances at risk if not prevent lower-income patients from getting needed care. Broad support for the bill came from consumer groups like Consumers Union, labor groups, and insurers. Recognizing that most stakeholders agreed with the overall goal of the legislation, Assemblyman Bonta promised to work with concerned physician groups and bill sponsors and supporters on an independent dispute resolution process to ensure a fair payment between the insurer and the non-contracting physician. Committee members appreciated attempts to improve the bill, and acknowledged the need to get the consumer out of the middle of what is ultimately a dispute between plans and providers.
  • SB 137 (Hernández) is in suspense in Appropriations Committee. Sponsored by Health Access, Consumers Union, and the California Pan-Ethnic Health Network, SB137 would set stronger standards for provider directories and establish more oversight on accuracy so people know whether their doctor and hospital are in network when they shop for coverage, change coverage, or try to use their coverage to get care.
  • AB 339 (Gordon), which builds on existing California law and federal guidance to put limits on how much insurers can shift cost-sharing for consumers for certain prescription drugs, has passed committee and is due to be heard in Assembly Appropriations. The bill would define what drugs could be placed on a high cost-sharing tier and put a monthly cap on such cost-sharing. Otherwise, under current drug benefits some consumers are expected to pay hundreds or thousands of dollars a month for a single prescription–even though the average consumer has only $2,300 in their savings account. AB339 takes the consumer out of the middle of the payment fight between insurers and drug companies.
  • Another important Health Access-sponsored bill, AB 1305 (Bonta) on limitations on cost sharing in family coverage passed policy committee unanimously. This bill ensures that the ACA individual out-of-pocket maximum (now $6,600) will apply to individual patients—even if they are in a family plan (which has an overall family out-of-pocket max of $13,200). This bill will be heard next in Assembly Appropriations.
  • Furthest along in the process is Health Access-sponsored AB 248 (Hernández), which would prohibit sale of subminimum coverage by insurers to large employers. This bill has already passed the Assembly Floor with a vote of 51-27 and is headed to the Senate for review.

TRANSPARENCY: A couple of bills to advance transparency in our health system are moving through the process. SB 26 (Hernández), which would establish and fund a health care cost and quality database, passed both the Senate Health Committee and the Senate Judiciary Committee. SB26 will make valid, timely, and comprehensive health care performance information publicly available and for use to improve the safety, appropriateness, and medical effectiveness of health care, and to provide care that is safe, medically effective, patient-centered, timely, affordable, and equitable. The author worked with Health Access and other key stakeholders to incorporate important amendments dealing with equity, the social determinants of health, and privacy. Advocates are continuing to work with the bill’s author on governance and other issues so this new database is as effective as possible.

SB546 (Leno), which would extend rate review to large group health coverage, meaning that large employers would have to justify above-average rate increases, has passed two committee hearings. Despite amendments taken in committee to remove “prior approval” rate regulation, the bill would still require important disclosures and require insurers to publicly justify their rates. With overall health care costs slowing, it’s important to ask why many premiums are still going up faster than the rate of inflation in California. While the Affordable Care Act took important steps to limit premium costs and justify rate increases, additional reforms are needed at the state level to get a better handle on premium costs.

MEDI-CAL: Several bills advanced to improve the Medi-Cal program, now covering almost 12 million Californians. AB 1231(Wood) would ensure access to specialty care in Medi-Cal through nonmedical transportation. AB 635 (Atkins) would require the Department of Health Care Services to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services to Medi-Cal beneficiaries with limited English proficiency.

AB 366 (Bonta) and a companion measure (SB 243 by Hernández) would restore Medi-Cal provider reimbursement rates from the previous budget cut in the first year and bring Medi-Cal rates up to Medicare levels in future years.

TOBACCO CONTROL: A number of bills take aim at the lingering problem of tobacco use and its deadly (and costly) consequences. SB 591 (Pan), and a companion bill AB 1396 (Bonta), would raise the tobacco tax, thus improving health by reducing smoking rates and cigarette consumption in our state, and also raise funds to improve Medi-Cal rates and access. AB 1396 (Bonta) was heard in Assembly Appropriations and has been referred to the suspense file. SB 591 (Pan) is due to be heard next in Senate Appropriations. A similar measure, SB 140 (Leno), would change the definition of tobacco products to include e-cigarettes, thus subjecting such products to the same regulations as other tobacco products.

OTHER KEY CONSUMER BILLS: A full matrix of all the active bills supported by Health Access and other health and consumer advocates is available online (here), including further ACA implementation legislation like SB 43 (Hernández), which would extend the sunset date on essential health benefits standards from 2016 to 2018 and incorporate recent changes in federal guidance regarding habilitative care (services that help you keep, learn, or improve skills and functioning for daily living), passed out of committee with a unanimous vote.

STALLED: Health advocates were able to defeat most of the bad bills, but some worthy bills also stalled. The biggest disappointments for health advocates include:

  • AB 463 (Chiu) on prescription drug pricing transparency also failed in committee. This bill would have facilitated transparency on the different components or cost centers that make up the final price of specialty drugs: the cost of production, research and development, clinical trials and regulatory and acquisition costs, materials and manufacturing, marketing and advertising, and total profits. Supporters, including Health Access, consumer groups, insurers, labor unions, and business groups, hoped that such intelligence would help lay the groundwork for deeper solutions to the increasingly vexing problem of high cost specialty medications. Bill author Assemblymember Chiu intends to bring the bill back next year.
  • SB 203 (Monning), which would have required warning labels on sugar sweetened beverages, failed in committee with a vote of 4-1 with four Senators abstaining, including committee Chair of the Senator Hernández and Senator Roth, Senator Nguyen and Senator Hall. Senator Nielsen was the only No vote. Although the bill failed in committee, the sponsors (California Center for Public Health Advocacy, California Black Health Network and the Latino Health Access) are committed to bringing this bill back next year.
  • SB 346 (Wieckowski) on hospital community benefits also failed in committee earlier this week with a vote of 4-2 with three Senators abstaining, including Senator Roth, Senator Pan and Senator Wolk. Senator Nguyen and Senator Nielsen were both No votes.  This bill would have established a new hospital community benefit law to require private non-profit hospitals to complete a community needs assessment, followed by a community benefits plan. Unfortunately, the bill failed in committee with a vote of 4-2.