New Health Laws and Fresh Opportunities for the New Year

The New Year 2015 brings fresh opportunity to deliver on the promise of health reform and affordable coverage and care, with several new laws going into effect today.

SB964 (Provider Network Adequacy (Hernandez) addresses the issue of narrow networks and whether enrollees in health plans (including but not limited to those in Covered CA and Medi-Cal) have adequate access to care.  With more and more Californians signing up for coverage in this second open enrollment season, this law, which requires the Department of Managed Health Care (DMHC) to provide stronger oversight of network adequacy, was long overdue.

Of course passing the law was only the first step. The action now moves to the regulatory front, starting with a substantive stakeholder process at the Department of Managed Health Care. Health Access and other bill sponsors will also look to Covered California to set stronger standards for network adequacy and timely access in their model contracts for 2016 qualified health plans, leaning on the state marketplace’s role as an “active purchaser.”

SB1276 Hospital Fair Pricing: Low-income Californians (<350 % of poverty) faced with a hospital bill will be eligible for a “reasonable payment plan,” meaning their payments will be capped at 10 percent of income after living expenses are taken into account. This law, updating a 2006 Hospital Fair Pricing law, goes to the heart of a sobering reality, that even after the implementation of the Affordable Care Act, for all of its positive impacts and results in the Golden State, there will be too many Californians without affordable coverage options.

Plenty of Californians still find themselves on hospital bill away from financial crisis. For example, Under the ACA workers whose out-of-pocket premium costs consume more than 8% of income qualify for subsidies in Covered California. But a federal interpretation of the law states that if single employee coverage consumes <8% of income but family coverage consumes more than 8%, then subsidies are unavailable for the family—leaving some spouses and children without an affordable coverage option. Too many immigrants are left out of the ACA’s guarantees of affordability and will therefore benefit from the new hospital fair pricing standards. And speaking of immigrants…

Maximizing the Impact of President’s Executive Order on Immigration for immigrant families’ health care access. The President’s executive order expands those eligible for deferred action status, keeping many immigrant families in tact and safe from deportation. While the exclusion from federal ACA benefits stands, immigrants with “deferred action” status who are at or below the poverty level will be able to get Medi-Cal coverage under existing state law–including the California residents, mostly parents, provided relief under the President’s order.

But given that only a fraction of DACA-eligible youth have enrolled in state-funded Medi-Cal, the pressure is on to minimize barriers to enrollment for these families and to create the assurances that enrollment and coverage will not pose any risk of deportation. It’s a formidable undertaking: but we can’t think of anything more worthwhile as a step toward truly universal coverage in the Golden State.

May we work for a healthier California in the new year!