In this article…
- SB 4 Would Take Historic Steps to Cover Remaining Uninsured
- Patient Protection Bills to Limit Out-of-Pocket Costs
- Other bills on transparency, Medi-Cal, and more
This blog entry was written by Sawait Hezchias-Seyoum, Health Care Policy Advocate, Health Access.
The Senate and Assembly adjourned yesterday, one day ahead of the June 5th deadline to pass all bills out of the first legislative chamber. The good news is that most key bills of interest to health care consumers have passed out of the house of origin, while one bill, opposed by public health groups, was defeated. Bills moving forward deal with limits and protections against unfair out-of-pocket costs; efforts at improving Medi-Cal; and a significant expansion of access to coverage for all regardless of immigration status.
For details on each bill, see our weekly bill matrix.
The most-watched health bill was SB4, the first bill to pass a state legislative body that would explicitly expand coverage regardless of immigration status. The California Senate passed SB4 on a historic and bipartisan vote, 28-11, with all Democratic senators and 2 Republican senators voting in support. This bill, which continues California’s path to #Health4All, moves on to the Assembly Health Committee for consideration.
With last week’s amendments in the Senate Appropriations Committee, SB 4 would:
- Expand Medi-Cal eligibility to all children regardless of immigration status, as an entitlement;
- Expand coverage for undocumented adults as budget allocations will allow (to be decided each year in the budget, and that enrollment will be capped if funding runs out).
- By way of a Section 1332 waiver (a formal request to the federal government), SB 4 would allow all Californians to purchase coverage through Covered California using their own money.
Senator Ricardo Lara, author of SB 4, called the vote “historic” and one that Senators will remember long after their term is over. “We are talking about our friends, our families, our neighbors. Illness doesn’t care about our immigration status,” said Lara, describing the bill as still “realistic, balanced, and fiscally prudent.”
Several Senators rose to speak during the floor debate. From the opposing side, GOP Senators Jeff Stone, Janet Nguyen, and Bob Huff raised concerns about cost, arguing that expanding Medi-Cal was a “false promise” until the program addresses access issues. Several Democratic Senators responded to that argument, including Senator Richard Pan who stated, “We certainly need to make fixes to Medi-Cal, but certainly being on Medi-Cal is better than being uninsured.” Senator Isadore Hall derided “excuses,” Senator Ben Hueso wanted focus on the issue at hand: “We have a solution on the table, and we should move it forward.” Senator Hernandez rebutted concerns about cost: “The most inefficient way to provide health care is through the emergency room—we all pay for it.”
The most noteworthy speech was by GOP Senator Andy Vidak announcing his support for the bill while also raising the need to address Medi-Cal access issues and federal immigration reform. He and another Central Valley Republican, Senator Anthony Cannella, were the two GOP Senators to vote for the bill. Senator Nguyen abstained, with the rest of the caucus voting no.
This issue is currently pending in Budget Conference Committee as a $40 million item in the Senate’s budget proposal. The next week or two will make a big difference in whether enrollment under SB4 would start in the budget year 2015-16.
BILLS LIMITING OUT-OF-POCKET COSTS
Four Health Access-sponsored consumer protection bills to prevent unfair out-of-pocket costs passed out of their “house of origin” this week and are heading to the second half and second legislative chamber in the weeks ahead. The remaining sponsored bill, AB 248 (Hernandez) on large employer junk insurance is further along in the process, having passed out of the Assembly several weeks ago.
- Requiring Accurate Provider Directories: SB 137 (Hernandez) would set 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. SB 137 passed out of the Senate with bipartisan support. The final vote was 33-0.
- Preventing Surprise Bills: AB 533 (Bonta), which would protect patients from “surprise” bills from out-of-network doctors when they did the right thing by going to an in-network hospital, imaging center, or other facility, passed out of the Assembly with a vote of 74-1.
- Limiting Prescription Drug Cost Sharing: AB 339 (Gordon), which would prevent discrimination against consumers with health conditions by setting standards for cost sharing on prescription drugs passed out of the Assembly with a vote of 48-29.
- Capping Individual Out-of-Pocket Costs: AB 1305 (Bonta) on limitations on cost sharing in family coverage passed out of the Assembly with a vote of 78-0. 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).
- Prohibit Subminimum Coverage: AB 248 (Hernandez), which would prohibit sale of subminimum coverage by insurers to large employers passed out of the Assembly several weeks ago with a vote of 51-27 and will next be heard in Senate Health.
SB546 (Leno) would advance transparency in our health system by extending rate review to large group health coverage. This bill, which requires justification of above-average rate increases, passed out of the Senate with a vote of 23-16.
Other transparency bills faltered earlier this year, including SB 26 (Hernandez), which sought to create a health care cost and quality database, was held in Senate Appropriations Committee amid questions on how to finance it. Earlier in the process, AB 463 by Assemblyman Chiu to facilitate more disclosure on prescription drug costs was stalled in Assembly Health Committee. These efforts will likely be revisited in future years.
Several bills designed to improve the Medi-Cal program, which now covers almost 12 million Californians, advanced out of their house of origin.
- SB 33 (Hernandez), which would limit estate recovery in Medi-Cal to the federally required minimum of long-term care services and eliminate recovery from the estate of a surviving spouse of a deceased beneficiary, passed out of the Senate with a vote of 33-0.
- AB 1231 (Wood), which would facilitate practical access to Medi-Cal specialty care through coverage of nonmedical transportation, also passed out with a vote of 76-0.
- AB 635 (Atkins), which 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, passed out of the Senate with a vote of 72-2.
- AB 366 (Bonta), which would require the Department of Health Care Services (DHCS) to report to the Legislature on Medi-Cal access passed out of the Assembly with a vote of 77-0. Originally introduced as a measure to restore Medi-Cal provider reimbursement rates and bring them up to Medicare levels in future years, this bill came out of the Appropriations Committee’s suspense hearing significantly scaled back in scope. A companion measure SB 243 (Hernandez) was held in Appropriations during the suspense hearing and is not moving forward.
A handful of bills aimed at the negative health impacts of tobacco use passed, including SB 151 (Hernandez) to raise the smoking age from 18 to 21. SB 140 (Leno), which would revise the definition of tobacco products to include e-cigarettes, thus subjecting such products to the same regulations as other tobacco products, passed out of the Senate with a vote of 25-12. Public health groups, including the Heart Association, Lung Association, and Health Access supported that measure and opposed the related bill SB 24 (Hill), which did not classify e-cigarettes as tobacco. Research suggests that e-cigarettes have much the same negative effect as cigarettes. SB 24 (Hill) failed passage.
OTHER KEY CONSUMER BILLS
A full matrix of the latest on all active bills supported by Health Access and other health and consumer advocates is available online (here). That list includes ACA implementation legislation like SB 43 (Hernandez), 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); AB 1117 (Garcia) would help bring more resources to Medi-Cal to improve immunization rates for 2-year-olds and AB 1299 (Ridley-Thomas) seeks to improve the delivery of mental health services for foster youth.
Now that these bills have passed the critical house of origin deadline, they will next be heard in the “other house,” meaning if the bill was introduced in the Assembly, it will be heard in the Senate, and if the bill was introduced in the Senate, it will be heard in the Assembly. Committee hearings will resume on June 8th. Policy committees have until July 17th to meet and report bills out of committee.
Stay tuned for tools and talking points to bring these bills to the finish line.