Press Releases

Press inquiries may be directed to:

Rachel Linn Gish, Director of Communications
rlinngish@health-access.org: 916-497-0923 ex. 809

Major Health Care Consumer Wins this CA Legislative Session

With the Governor's final actions on bills last week, health consumer advocates applauded a major year in health reform, where California continued its leadership on health care access, affordability, and equity.  
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  • The 2022 state legislative and budget year saw major progress towards lowering costs, improving quality, and increasing equity for California’s health care consumers.
  • Key bills and budget items that didn’t succeed this session will continue to be a focus in the new year.

SACRAMENTO, CA — With the Governor’s final actions on bills last week, health consumer advocates applauded a major year in health reform, where California continued its leadership on health care access, affordability, and equity.  While advocates were disappointed in some missed opportunities to help Californians better afford health coverage, they highlighted many of the concrete steps taken this year to improve our health care system. Here’s a round-up of actions from the 2022 legislative and budget session that will affect millions of Californians:

IMPROVING MEDI-CAL ACCESSIBLITY AND EQUITY:

  • #Health4All: The state budget signed in June of this year makes the historic step to remove ALL barriers in Medi-Cal based on immigration status. Starting in January 2024, all income-eligible undocumented Californians will be able to enroll for comprehensive health care coverage through Medi-Cal, and finally have access to preventative health care services along with vision, dental, and specialist care. California will be the first state in the nation to advance such a reform, building off years of work to expand Medi-Cal access to undocumented kids (2016), young adults (2020) and older adults (2022).
  • Additional 2022-23 budget investments:
    • Eliminates premiums in Medi-Cal for hundreds of thousands of children, people with disabilities and others who were just over certain income thresholds.
    • Reduces Medi-Cal share-of-cost for low-income seniors and people with disabilities.
    • Continuous coverage for Medi-Cal for young children up to age five.
  • The Governor signed SB 1019 (Gonzalez) that prioritizes culturally and linguistically relevant outreach to Medi-Cal enrollees about mental health benefits covered by their plans. An important step to address racial disparities in accessing mental health care in Medi-Cal.
  • Missed opportunity: The Governor vetoed AB 1930 (Arambula), a #Care4AllCA priority bill, that would have ensured comprehensive perinatal services in Medi-Cal, making it more difficult for moms with social needs to access low-cost care the first year after a baby is born.

OFFICE OF HEALTH CARE AFFORDABILITY:

  • A years-long effort to create an Office Health Care Affordability within the Department of Health Care Access and Information culminated in a budget investment this year. It represents California’s biggest effort in years to address the longstanding concern about rising health care costs.
  • The purpose of the new Office is to slow the fast-inflating price of health care for all Californians, regardless if they get coverage through an employer, public program, or individually.
  • Once it’s up and running it will accomplish this by setting enforceable cost targets for the health industry, with accountability and commensurate fines if they are not able to justify higher increases.

LOWERING COSTS IN COVERED CALIFORNIA:

  • Missed opportunity: Deductibles and co-pays continue to be a major barrier to accessing care for many in Covered California. The state had funds allocated to allow Covered California to eliminate or lower these costs for hundreds of thousands of Californians. After the enactment of the Inflation Reduction Act this summer, premium spikes in Covered California were prevented, but Governor Newsom did not take the next step to use state funds to lower cost-sharing, instead vetoing SB 944 (Pan). Covered California enrollees in silver plans will now see their deductibles rise to nearly $5,000 next year.

HEALTH INSURER ACCOUNTABILITY:

  • Governor Newsom signed SB 858 (Wiener) to modernize and increase penalties levied by the Department of Managed Health Care – from a maximum of $2,500 to $25,000 – when health plans violate the law and patient protections such as timely access to care, adequate network standards, language access, behavioral health care services, gender-affirming care, and more. Some of these fine amounts had not been updated since 1975.
  • Governor Newsom signed SB 923 (Wiener) making California the first state to require training and professional standards for health care providers for their transgender and TGI patients. SB 923 also requires health plans to indicate in their network directories which physicians provide gender-affirming care.
  • Missed opportunityAB 2080 (Wood) stalled in the legislature this year, but advocates plan to continue the push to give California’s Attorney General enhanced oversight on for-profit hospital and health industry mergers to ensure they are in the public interest.

PRESCRIPTION DRUGS:

  • In the budget, the Administration included $100 million to directly contract to manufacture generics, starting with insulin, in order to bring the price of the drug down.
  • Governor Newsom signed SB 838 (Pan), in relation to the budget investment, to better define the state’s plan to directly contract to manufacture generic prescription drugs.

CONNECTING CALIFORNIANS TO CARE:

  • Governor Newsom signed a series of bills that will help keep Californians get on and stay on health coverage, connecting them to their health plan options.
    • SB 644 (Leyva) allows California’s Employment Development Department to share contacts with Covered California for follow-up, ensuring that those losing their jobs, and likely their health benefits as well, are aware of their options for affordable health care plans through the state’s health insurance marketplace.
    • AB 2530 (Wood) provides health benefits through Covered California to workers and their families who lose health benefits during a labor dispute.
    • SB 967 (Hertzberg) adds a check box on state tax forms for people to indicate if they are interested in receiving information about low-cost health care coverage options.

“Californians will see both short and long-term benefits from the bills and budget items adopted by Governor Newsom and the state legislature this year,” said Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition. “Californians should see lower costs—whether from reduced premiums in Medi-Cal immediately, or from the broader oversight eventually provided by a new Office of Health Care Affordability. Hundreds of thousands of Californians will have better access to care in Medi-Cal and private plans, including children, seniors, undocumented, and LGBTQ Californians. State regulators will have more tools to ensure patient protections are followed and Californians can access care when and where they need it. Californians will hopefully find it easier to get on and stay on care, especially when filing their taxes, for unemployment insurance, or when going on strike.”

“California policymakers took impressive steps toward a vision of a more accessible, affordable, and equitable health system this year. We look forward to the work to implement these reforms as well as continue the unfinished work toward universal coverage,” said Wright.

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    Governor Newsom Signs Key Bills to Keep Californians Covered

    Governor Newsom has signed a series of bills that will help keep Californians get on and stay on health coverage, connecting them to their health plan options. 
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    • Governor Newsom has signed a series of bills that will help keep Californians get on and stay on health coverage, connecting them to their health plan options. 
    • Today, he signed SB 644 (Leyva) which will connect those filing for unemployment insurance to Covered California and their health plan options.
    • Earlier this week, Newsom signed AB 2530 (Wood) to provide Covered California health benefits to workers that lose their health benefits while on strike.
    • Last month, the Governor signed SB 967 (Hertzberg) to add a check box on tax forms, to connect uninsured Californians with their Covered California and Medi-Cal health plan options.

    SACRAMENTO, CA — Governor Newsom has taken action on a number of bills that will help keep Californians covered and better connect them to their health plan options.

    Today he signed SB 644 by Senator Leyva to allow California’s Employment Development Department (EDD) to share contacts with Covered California for follow-up, ensuring that those losing their jobs, and likely their health benefits as well, are aware of their options for affordable health care plans through the state’s health insurance marketplace.

    “In our current system, health care is closely tied to employment. When people lose their jobs, they often also lose their health benefits. California can now connect those who apply for unemployment benefits to their health coverage options,” said Jose Torres Casillas, policy and legislative advocate for Health Access California, a co-sponsor of SB 644. “This new law will help prevent harmful gaps in coverage and the health and financial consequences of becoming uninsured.”

    Complementary to other bills in the #Care4AllCA package that expand health care access and affordability, SB 644 is one of three bills highlighted by the coalition that focused on making health coverage administratively easy to sign up for like when people are filing their taxes, for unemployment insurance, or going on strike. Also recently acted on by the Governor are:

    • SB 967 (Hertzberg): Connecting Taxpayers to Coverage Information. Since many Californians are uninsured due to lack of information about their options, Governor Newsom last month signed this bill that will add a check box on state tax forms for people to indicate if they are interested in receiving information about low-cost health care coverage options. The bill was co-sponsored by Health Access California and the American Heart Association.
    • AB 2530 (Wood): Keeping Striking Workers Covered. This new law, signed by the Governor this week, provides health benefits through Covered California to workers and their families who lose health benefits due to a labor dispute. Exercising their right to strike should not mean a worker loses health coverage for themselves or their families.

    “These new laws will be key to connecting Californians with coverage, especially during life transitions or when engaging with other state agencies. In our fragmented health system, these laws will help prevent Californians from falling through the cracks of coverage and make it easier to get on and stay on health insurance,” said Anthony Wright, executive director of Health Access California. “As we seek to make health coverage more accessible and affordable, we also need to make signing up more administratively simple, if not automatic. California is taking these important steps to make our health system a bit more seamless, so people don’t fall off coverage and face gaps in care.”

    BACKGROUND:

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      Governor Newsom Signs Bill to Raise Fines on Health Plans for Patient Protection Violations

      Governor Newsom today signed SB 858 (Wiener) which will increase the level of fines for health plans who violate patient protections and modernizes outdated standards.
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      • Governor Newsom today signed SB 858 (Wiener) which will increase the level of fines for health plans who violate patient protections and modernizes outdated standards.
      • These DMHC fines have not been updated since 1975. The new law will incentivize plans to improve their practices, and not just pay the fine as the cost of doing business.

      SACRAMENTO, CA – On the final day to take action on legislation on his desk, Governor signed SB 858 by Senator Scott Wiener updating penalty amounts that the state can levy on health plans that don’t meet state consumer protection standards. It will go into effect on January 1, 2023.

      Despite strong consumer protections for Californians in health plans regulated at the Department of Managed Health Care (DMHC), many have still been denied or delayed in getting medically necessary services. Yet fine amounts for violations related to grievance handling and other specific consumer protections had not been updated for decades, all while health insurance premiums have not just doubled, but quadrupled since 1999. Some of these fine amounts had not been updated since 1975 when gas was 59 cents a gallon.

      The new law increases the maximum fines from $2,500 per violation to $25,000 when they violate standards such as timely access to care, adequate network standards, language access, behavioral health care services, gender-affirming care, or other consumer protections.

      “For years health care corporations have been skirting consumer protection laws with minimal consequences. This new law will change the behavior of these health plans and ensure access to needed care for Californians,” said Diana Douglas, Health Access California’s director of policy and legislative advocacy.

      “Californians rely on their health insurance to cover critical, even life-saving, care, and we must hold health plans accountable for following the rules and providing timely and adequate coverage,” said Senator Wiener. “California’s low, outdated fine levels allow health plans to view these fines as a mere cost of doing business. SB 858 makes clear that when we pass a law requiring coverage, we mean it.”

      Even for the biggest, headline-making penalties in recent years, the fines didn’t necessarily match the severity and breadth of the violations. Just this year, L.A. Care was fined a historic $35 million by DMHC for failure to appropriately handle grievances and for a severe backlog of authorization requests for services over a five year span. However, with over 67,000 grievances and over 9,000 requests for authorization, this seemingly large fine amounted to only a few hundred dollars per instance—essentially less than a speeding ticket for delaying or denying care to a patient. Meanwhile, the plan reported a tangible net equity of over $1 billion, an amount $923 million over that which is required by law

      This new law will give DMHC the additional authority to levy higher fines and impose corrective action plans when necessary. It will also modernize penalty amounts every 5 years, and updates the methodology to ensure the penalty amounts reflect the true harm caused to enrollees.

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        Deductibles to Spike as Governor Vetoes Legislation to Lower Out-of-Pocket Costs in Covered California

        Hundreds of thousands of Californians with Covered California health plans will likely see their co-pays go up and deductibles rise by over one thousand dollars next year, as a result of Governor Gavin Newsom’s veto yesterday of SB 944 by Senator Pan. That bill sought to lower cost-sharing in Covered California, including eliminating deductibles in silver plans.
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        • Last night, Governor Newsom vetoed SB 944 (Pan), which would have eliminated deductibles and lowered co-pays for hundreds of thousands in Covered California.
        • With the veto, Covered California is expected tomorrow to raise deductibles in silver plans over $1,000 next year, to $4,750. The cost of seeing a doctor will increase to $45, and $85 for a specialist. 
        • California’s state budget had already allocated $304 million for Covered California affordability assistance, that was to be used for premiums in the event of the loss of federal subsidies, or for other cost-sharing if those subsidies were extended. 
        • Health advocates decry this decision and urge the state to continue the commitment to invest at least the amount of money raised from the individual mandate penalty to lowering the cost of care for Californians. 

        SACRAMENTO, CA – Hundreds of thousands of Californians with Covered California health plans will likely see their co-pays go up and deductibles rise by over one thousand dollars next year, as a result of Governor Gavin Newsom’s veto yesterday of SB 944 by Senator Pan. That bill sought to lower cost-sharing in Covered California, including eliminating deductibles in silver plans.

        “In a year of rising costs, Californians are crying out for affordability help. There is $304 million in already-allocated state funds available to reduce out-of-pocket health care costs for hundreds of thousands of Californians, and Covered California and health plans have been ready to go. But as a result of the Governor’s veto, these Californians will now face deductibles of almost $5,000 next year, and perhaps more in the years ahead,” said Anthony Wright, executive director of Health Access California, the sponsor of SB 944.

        “Governor Newsom’s disappointing veto will mean higher cost-sharing for Covered California enrollees, including a spike in deductibles of over $1,000 in silver plans. Instead, California should have used this money for its stated purpose – to lower the costs of care for Californians,” said Diana Douglas, director of policy and legislative advocacy at Health Access California. “This counterproductive veto discourages Californians from getting care and coverage and is a significant setback to the goal of getting to a universal, affordable health system.”

        Without this cost-sharing help, low- and middle-income Californians face significant out-of-pocket costs that are major financial barriers to care. High out-of-pocket costs, especially deductibles, lead people who have coverage to avoid needed care and keeps some people from purchasing care at all, or face debt for seeking care. Without this investment, those who earn just over $2,000 per month will have hospital deductibles of $800, and middle-income Covered California enrollees will have deductibles approaching $5,000 and pay $45 for a single primary care visit in a silver level plan.

        “California is one of the few states that requires people to purchase health plans or pay a penalty—but at the same time the Governor offered state subsidies to make such coverage more affordable. With premium subsidies covered by the federal government, Governor Newsom should use the funds raised from the penalty on those who are uninsured to invest in additional affordability assistance. California should not be collecting hundreds of millions of dollars a year from the uninsured without making a similar investment in reducing the cost of coverage in order to make it easier for more Californians to be insured,” said Douglas.

        After a year of studying options with an extensive report on the ways to reduce cost sharing, in June 2022 the Covered California board adopted a plan that if the federal government extended enhanced premium assistance, as it just did this summer under the Inflation Reduction Act, then Covered California would use state dollars to lower cost-sharing. This would have removed financial barriers to care, encourage more Californians to sign up for coverage, and bring the state closer to a system of universal, affordable coverage. With this veto from the Governor, the Covered California board on Thursday is likely to reverse that plan and allow cost-sharing and deductibles to spike. In a standard silver plan, a primary care visit will be $45, a specialist visit will be $85, and the deductible for a hospital stay would be $4,750.

        Under Governor Newsom in 2019, California took a leadership role in passing both an individual mandate to purchase coverage “to pay for increased financial help for families” as his press release on his first day declared, and state premium subsidies. After his budget proposal passed in July 2019, his press releases highlighted the new state subsidies to provide greater affordability assistance, “partially funded by restoration of an enforceable mandate.” When additional federal premium assistance supplanted state subsidies for 2021 and 2022, and now until 2025 through the Inflation Reduction Act, legislators and advocates have urged that the state dollars still raised from the mandate penalty go to reduce ever-increasing cost-sharing.

        Governor Newsom’s veto of SB 944 likely closes the door on this help for Covered California consumers in 2023, despite the promises made when the individual mandate penalty was imposed on all California consumers in 2019.

          CA Legislature Passes Bills to Better Connect Californians to Health Coverage

          The California Legislature has recently passed a number of bills that will help keep Californians covered and better connect them to their care options.
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          • 3 bills recently passed by the California Legislature will help keep Californians covered and connect them to their care options:
            • Passed yesterday is SB 644 (Leyva) which allows EDD to connect those filing for unemployment coverage to Covered California and their health plan options.
            • Passed earlier this week is AB 2530 (Wood) to provide Covered California health benefits to workers that lose their health benefits while on strike.
            • Last week, Governor Newsom signed SB 967 (Hertzberg) to add a check box on tax forms for those that are uninsured and want information on their health plan options.

          SACRAMENTO, CA — The California Legislature has recently passed a number of bills that will help keep Californians covered and better connect them to their care options.

          Yesterday, the California Legislature passed SB 644 (Leyva) to make sure Californians filing for unemployment insurance, and likely losing not just their job but their health benefits, are connected to Covered California and their options for health plans and affordability assistance. The two-year bill, sponsored by Health Access California, California Pan-Ethnic Health Network, and Western Center on Law and Poverty, would have California’s Employment Development Department share contacts with Covered California for follow-up. It received bipartisan support and now goes to Governor Gavin Newsom for his signature by the end of September.

          “In America, health care is closely tied to employment so when people lose their jobs, they often also lose their health benefits. California should use the opportunity when Californians apply for unemployment benefits to ensure that they continue to be covered,” said Jose Torres Casillas, policy and legislative advocate for Health Access California. “We hope Governor Newsom signs this bill to help prevent harmful gaps in coverage and the health and financial consequences of becoming uninsured.”

          Complementary to other bills in the #Care4AllCA package that expand health care access and affordability, SB 644 is one of three bills that focuses on making health coverage administratively easy to sign up for like when people are filing their taxes, for unemployment insurance, or going on strike. Also recently acted on by the Legislature and Governor are:

          • SB 967 (Hertzberg): Connecting Taxpayers to Coverage Information. Many Californians continue to be uninsured due to lack of information about their options. Signed by Governor Newsom last week, this new law will add a check box on state tax forms for people to indicate if they are interested in receiving information about low-cost health care coverage options. [Co-Sponsored by Health Access California and the American Heart Association]
          • AB 2530 (Wood): Keeping Striking Workers Covered. Exercising their right to strike should not mean a worker loses health coverage for themselves or their families. This bill would provide health benefits through Covered California to workers and their families who lose health benefits due to a labor dispute. The bill is now on the Governor’s desk. [Co-Sponsored by California Labor Federation and SEIU CA State Council]

          “These key bills help connect Californians with coverage, especially during life transitions or when engaging with other state agencies. In our fragmented health system, we should do everything we can to prevent Californians from falling through the cracks of coverage and make it easier to get on and stay on health insurance,” said Anthony Wright, executive director, Health Access California. “California has taken important steps to universal coverage, but we have more to do, to make coverage more accessible, affordable, and also more administratively simple, if not automatic. These bills represent the next step in making our health system a bit more seamless, so people don’t fall off coverage and face gaps in care.”

          BACKGROUND:

            CA Legislature Sends Bill to Lower Out-of-Pocket Costs in Covered California to Governor’s Desk

            Hundreds of thousands of Californians with Covered California health plans could see their deductibles eliminated and co-pays substantially reduced next year, thanks to current subsidies and pending actions.
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            • The signing of the Inflation Reduction Act extended federal funding to ensure affordable premiums in Covered California, saving California from having to backfill that investment with state dollars. 
            • In light of this federal action, today the California Legislature passed SB 944 (Pan) that re-commits California to use already allocated $304 million in state investments to lower out-of-pocket costs for those in Covered California.
            • State action can zero out deductibles. If not, silver plan deductibles could rise over $1,000 to $4,750 per person next year.

            SACRAMENTO, CA – Hundreds of thousands of Californians with Covered California health plans could see their deductibles eliminated and co-pays substantially reduced next year, thanks to current subsidies and pending actions. Today the California State Legislature passed SB 944 by Senator Pan which was recently amended to enact a budget commitment to lower cost-sharing in Covered California, now that Congress has passed federal premium subsidy assistance. SB 944 fills key affordability gaps in Covered California, lowering cost-sharing and eliminating deductibles for many of the over 1.5 million Californians getting coverage through the state marketplace. The bill now awaits action by Governor Newsom.

            SB 944, sponsored by Health Access California, removes financial barriers to care for hundreds of thousands of patients, and encourages even more Californians to sign up for coverage, getting California closer to its goal of universal health care. This move is made possible by Congress passing and President Biden signing the Inflation Reduction Act which guaranteed financial help for Covered California enrollees, capping premium costs at no more than 8.5% of income. Without that law, California enrollees would have seen major premium spikes, and the state would have partially backfilled the loss of federal assistance with $304 million in state subsides. But, with the Inflation Reduction Act in place, California can now enact the plan adopted by Covered California to use that money to instead reduce out-of-pocket health care costs in Covered California. SB 944, along with AB 1878 by Assemblymember Wood were introduced earlier this year with the intent to take this step in California this year.

            Without this cost-sharing help, low- and middle-income Californians face significant out-of-pocket costs that are major financial barriers to care. High out-of-pocket costs, especially deductibles, lead people who have coverage to avoid needed care, or face debt for seeking care, and keeps some people from purchasing care at all. If no action is taken, middle-income enrollees will see deductibles rise over $1,000, to $4,750, and pay $45 for a single primary care visit in a Silver-level plan.

            “California’s goal of universal coverage is within reach, but not if people are still priced out of care due to high deductibles and co-pays for office visits,” said Diana Douglas, Director of Policy and Advocacy at Health Access California. “Californians who pay the penalty for not having health care coverage often do so because they can’t afford the coverage. SB 944 ensures that at least the same amount of money raised from the penalty goes right back into lowering the cost of care, helping more people get covered in the first place. We urge Governor Newsom to sign this bill and help California lead the way yet again and truly make health care coverage a reality for all.”

            “I am proud of the investments my colleagues and I have led in California to expand health care coverage since the initial passage of the Affordable Care Act. Health insurance is only beneficial if people are able to use it to access primary, preventive, specialty, and acute care, when needed. That’s why SB 944 is so critically needed. With Governor Newsom’s signature, California can continue to lead by offsetting copayments and eliminating deductibles so Californians can get the care that they need without the worry of prohibitive cost sharing that creates barriers and delays to accessing quality health care,” said Senator Dr. Richard Pan, Senator (D-Sacramento).

            “We have been very grateful for the continuing support Governor Newsom and his Administration has provided to improve health care coverage and affordability for California families,” said Assemblymember Jim Wood (D-Healdsburg). “With the federal Inflation Reduction Act and funding we approved in June’s state budget, the Governor’s signature would make sure that Covered California removes the burden of copays and deductibles as we envisioned. People will actually be able to get care, instead of fearing the burden of copays and deductibles that often prevents them from seeking the care they need.”

            Using funds raised from the individual mandate penalty, SB 944 would invest in zeroing out deductibles and reducing co-pays to help more people afford coverage. Specifically, the bill would:

            • Zero deductibles for every consumer who selects a silver plan, eliminating deductibles of as much as $4,750 for many middle-income enrollees, $800 for low-income enrollees, and $75 for the lowest income who have federal cost sharing reductions.
            • Lower copays for many services for the standard silver plan:
              • $30 for a primary care visit instead of $45
              • $10 for generic drugs instead of $16
              • $40 for preferred brand name drugs instead of $55

            Covered California is expected to finalize health plan design in their September 15th meeting. Governor Newsom has until September 31 to act on this bill.

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              Bill to Raise Fines on Health Plans Heads to Governor’s Desk

              Today the Legislature approved passage of SB 858 by Senator Scott Wiener which updates penalty amounts that the state can levy on health plans that don’t meet state consumer protection standards. It now goes to Governor Newsom for final signature.
              READ MORE

              For immediate release:  Thursday, August 25, 2022

              • SB 858 (Wiener) increases the level of fines for health plans who violate patient protections and modernizes outdated standards.
              • These DMHC fines have not been updated since 1975. The bill incentivizes plans to improve their practices, and not just pay the fine as the cost of doing business.

              SACRAMENTO, CA – Today the Legislature approved passage of SB 858 by Senator Scott Wiener which updates penalty amounts that the state can levy on health plans that don’t meet state consumer protection standards. It now goes to Governor Newsom for final signature.

              Despite strong consumer protections for Californians in health plans regulated at the Department of Managed Health Care (DMHC), many are still denied or delayed in getting medically necessary services. Yet fine amounts for violations related to grievance handling and other specific consumer protections have not been updated for decades, all while health insurance premiums have not just doubled, but quadrupled since 1999. Some fine amounts have not been updated since 1975 when gas was 59 cents a gallon.

              The bill, sponsored by Health Access, increases the maximum fines imposed by DMHC from $2,500 per violation to $25,000 when they violate standards such as timely access to care, adequate network standards, language access, behavioral health care services, gender-affirming care, or other consumer protections.

              “California has some of the strongest health consumer protections in the country, but those are meaningless if health plans don’t follow the law. Many people have been denied or delayed critical care while these plans only get a fine that amounts to a slap on the wrist,” said Diana Douglas, Health Access California’s director of policy and legislative advocacy. “We can’t let health corporations just skirt the law with minimal consequences. By signing this bill, Governor Newsom can help change the behavior of these health plans to ensure access to needed care for Californians.”

              “California has many strong consumer protections for patients in our healthcare system,” said Senator Wiener. “But if health plans don’t comply with these laws – and don’t face any meaningful consequences when they don’t – then California residents aren’t going to get the care they need. Fine amounts have stayed the same over the past 47 years, while health plan premiums have skyrocketed. SB 858 updates fine amounts for plans, so they have a real incentive not to break the law.”

              Even for the biggest, headline-making penalties in recent years, current fines don’t necessarily match the severity and breadth of the violations. Just this year, L.A. Care was fined a historic $35 million by DMHC for failure to appropriately handle grievances and for a severe backlog of authorization requests for services over a five year span. However, with over 67,000 grievances and over 9,000 requests for authorization, this seemingly large fine amounts to only a few hundred dollars per instance—essentially less than a speeding ticket for delaying or denying care to a patient. Meanwhile, the plan reports a tangible net equity of over $1 billion, an amount $923 million over that which is required by law

              SB 858 gives DMHC the additional authority to levy higher fines and impose corrective action plans when necessary. SB 858 will modernize penalty amounts every 5 years, and updates the methodology to ensure the penalty amounts reflect the true harm caused to enrollees.

              Governor Newsom has until September 30 to take action on the bill.

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                Tens of Thousands of Young Adult Californians Will Keep Health Coverage Under New DHCS Action

                Health, community, and immigrant rights advocates applaud the action taken today by the California Department of Health Care Services (DHCS) to prevent tens of thousands of Californians from being dropped from Medi-Cal coverage.
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                • A projected 40,000 young adult Californians who are undocumented immigrants and covered in Medi-Cal through age 25 were set to “age out” in the next year, whenever the public health emergency ends.
                • Responding to advocacy by the #Health4All coalition, DHCS’ action allows them to stay covered until January 2024, when the exclusion based on immigration status in Medi-Cal will be fully removed.
                • Health, community, and immigrant advocates applaud this move that will prevent a gap in care for tens of thousands of Californians.

                SACRAMENTO,CA — Health, community, and immigrant rights advocates applaud the action taken today by the California Department of Health Care Services (DHCS) to prevent tens of thousands of Californians from being dropped from Medi-Cal coverage.

                Medi-Cal currently covers all income-eligible Californians, regardless of immigration status, up to age 25 and age 50 and older. This year’s state budget extends coverage to the remaining population, age 26-49, but not until January 2024. This meant that 40,000 young adults turning age 26 in the next year would have been faced with the possibility of losing coverage before being eligible again in January of 2024.

                The #Health4All coalition, made up of dozens of health, community, and immigrant groups that championed Medi-Cal inclusion for undocumented Californians, along with legislative champions Assemblymember Joaquin Arambula and Senator Maria Elena Durazo, raised this issue within DHCS and worked together to find a way to preserve this coverage and prevent gaps in vital health care services.

                “This action by California’s Department of Health Care Services is the right thing to do. Providing continuous coverage means that tens of thousands of young Californians won’t face a disruptions in care, keeping them covered and healthier as a result,” said Jose Torres Casillas, policy and legislative advocate for Health Access California, a co-chair of the #Health4All campaign. “California is again leading the way in making our health care system work better for all communities, regardless of income, age, or immigration status. As we’ve learned these last few years, all Californians benefit when we all have access to comprehensive, accessible health care services.”

                “The California Immigrant Policy Center welcomes today’s announcement from DHCS ensuring that 40,000 young adults will maintain their health coverage until Jan. 1, 2024, when Medi-Cal will be available to all Californians ages 26-49, regardless of immigration status,” said Connie Choi, Policy Director at the California Immigrant Policy Center, a co-chair of the #Health4All campaign. “Protecting these young adults–who currently have Medi-Cal–from losing coverage, only to become eligible again shortly thereafter, will prevent needless gaps in health care services and medication that people need. Securing this administrative action by DHCS could not have been possible without the advocacy of the Health4All Coalition.”

                The #Health4All campaign, co-chaired by the California Immigrant Policy Center and Health Access California, has been working to remove barriers in Medi-Cal due to immigration status for nearly a decade. Starting in 2016, the campaign advocated and won coverage in Medi-Cal for all income-eligible children regardless of immigration status. In 2020, young adults up to age 26 gained coverage and then in 2022, those 50 and older. This year saw the major victory of reaching #Health4All in Medi-Cal with a commitment in the budget to fully remove the exclusion based on immigration status, including for those 26-49 by January 2024.

                The national public health emergency (PHE) due to the COVID-19 pandemic currently prevents patients from being dropped from Medicaid coverage. However, when the PHE ends, all those in Medicaid would need to face a “redetermination” process to remain enrolled. Now, no matter when the PHE ends, DHCS will provide those turning 26 (or “aging out”) with state-funded full-scope Medi-Cal coverage to bridge the gap until full expansion occurs in January 2024. This will be done by instructing counties to deprioritize this population during their annual redetermination after the end of the public health emergency. DHCS updated the Medi-Cal COVID-19 PHE Operational Unwinding Plan to reflect changes to the policy for this population.

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                  President Biden Signs Historic Health Bill for Lower Premiums and Prescription Drug Prices

                  President Biden today signed the Inflation Reduction Act, the most significant advancement in addressing health care costs since the Affordable Care Act. The law will lower prescription drug prices by allowing the government to negotiate prices, while also capping out-of-pocket and insulin costs in Medicare. It also prevents pricey premium spikes for 1.5 million enrollees in Covered California.
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                  For immediate release:  Tuesday, August 16, 2022

                  PRESIDENT BIDEN SIGNS HISTORIC HEALTH BILL FOR LOWER PREMIUMS AND PRESCRIPTION DRUG PRICES

                  • Californians with Medicare and Covered California plans to especially benefit
                  • Seniors and others on Medicare get a cap on out-of-pocket drug costs, insulin co-pays, and more
                  • Covered California enrollees get extended affordability assistance, triggering state subsidies to lower cost-sharing
                  • While most of California’s Congressional delegation voted for the Inflation Reduction Act, all 11 Republicans voted against the bill, and with PHRMA and for higher health costs

                  SACRAMENTO, CA/WASHINGTON D.C. – President Biden today signed the Inflation Reduction Act, the most significant advancement in addressing health care costs since the Affordable Care Act. The law will lower prescription drug prices by allowing the government to negotiate prices, while also capping out-of-pocket and insulin costs in Medicare. It also prevents pricey premium spikes for 1.5 million enrollees in Covered California.

                  On Friday in a divided, party-line vote, all 42 California Democrats voted to pass the Inflation Reduction Act, and all 11 California Republicans voted against it.

                  “President Biden signing this law means millions of seniors in Medicare get a cap on out-of-pocket prescription drug spending, and another cap for insulin of $35 a month. Beyond the policy win of giving Medicare the ability to negotiate the price of prescription drugs, the cap provides a practical financial benefit for over 115,000 California seniors and people with disabilities than spend more than $2,000 in medications each year, and hundreds of thousands more Californians getting better access to insulin or vaccines,” said Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy organization.

                  “Biden’s signature means locking in reduced premiums and preventing premium spikes for over 1.5 million with Covered California plans and frees up state dollars that will allow California to go even further in making our health coverage more affordable,” said Wright. “As Californians continue to struggle with the high cost of living in our state, we urge the Governor and Legislature to invest in eliminating deductibles in Covered California silver plans and reduce co-pays. Deductibles should no longer discourage people from signing up for health insurance, or act as a financial barrier to needed care.”

                  In California, some of the impacts include:

                  • 114,775 Medicare Part D enrollees in California who experienced out-of-pocket costs over $2,000 in 2021 will now have their prescription drugs capped at $2,000 per year.
                  • Over 5 million Californians on Medicare will be protected from Big Pharma’s arbitrary price hikes that raise drug prices faster than inflation.
                  • 332,770 Californians on Medicare will have insulin copays capped $35 per month.
                  • 1,599,264 Californians will save on monthly health insurance premiums.

                  Health Access recently broke down additional impacts by state, county, regional, and Congressional districts.  Those that voted against the bill represent some of the most impacted constituents in the state, such as the Central Valley.

                  “We appreciate those California Congressmembers who fought the drug lobby to finally allow Medicare to negotiate the best price for prescription drugs. Those who opposed the act voted against lower prescription drug prices, and to double the premiums for over one million in Covered California plans,” said Wright.

                    Congress Votes to Pass Historic Health Bill that will Lower Premiums and Prescription Drug Costs for Californians

                    42 California Congressmembers voted with health care consumers in support of the Inflation Reduction Act. 11 voted against the bill and their California constituents, and with PHRMA and for higher health costs.
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                    For immediate release: Friday, August 12, 2002

                    CONGRESS VOTES TO PASS HISTORIC HEALTH BILL THAT WILL LOWER PREMIUMS AND PRESCRIPTION DRUG COSTS FOR CALIFORNIANS

                    42 California Congressmembers voted with health care consumers in support of the Inflation Reduction Act

                    11 voted against the bill and their California constituents, and with PHRMA and for higher health costs

                    SACRAMENTO, CA/WASHINGTON D.C. – In a historic vote, the U.S. House of Representatives today passed the Inflation Reduction Act, the most significant advancement in addressing health care costs since the Affordable Care Act. The bill seeks to lower prescription drug prices by allowing the government to negotiate prices, while also capping out-of-pocket and insulin costs for millions in Medicare. It also prevents pricey premium spikes for 1.5 million enrollees in Covered California.

                    In a divided, party-line vote, all 42 California Democrats voted to pass the legislation, and all 11 California Republicans voted against it.

                    “We greatly appreciate the California Congressional members who stood with health care consumers and against Big Pharma and higher health costs. As a result of this vote, those in Covered California will be shielded from premiums price hikes, and those on Medicare will have their prescription drug costs capped. Hundreds of thousands of Californians in Medicare, and over a million in Covered California, will directly benefit,” said Anthony Wright, executive director of Health Access California, the statewide health care consumer advocacy coalition.

                    “We are very disappointed that some California Congressmembers voted in lockstep with their party and with the prescription drug companies, and in doing so voted to raise health care costs on their own constituents. Californians are already dealing with a high cost of living so it’s puzzling why Congressmembers would vote against prescription drug price reform, or to double the premiums of tens of thousands of their own constituents. This vote was a big what-side-are-you-on moment for many Congressmembers, one that should be remembered by voters going forward.”

                    In California, some of the impacts include:

                    • 114,775 Medicare Part D enrollees in California who experienced out-of-pocket costs over $2,000 in 2021 will now have their prescription drugs capped at $2,000 per year.
                    • Over 5 million Californians on Medicare will be protected from Big Pharma’s arbitrary price hikes that raise drug prices faster than inflation.
                    • 332,770 Californians on Medicare will have insulin copays capped $35 per month.
                    • 1,599,264 Californians will save on monthly health insurance premiums.

                    Health Access recently broke down additional impacts by state, county, regional, and Congressional districts.  Those that voted against the bill represent some of the most impacted constituents in the state, such as the Central Valley.

                    “When President Biden signs this landmark legislation, it will be just in time to ensure that those signing up for Covered California during this fall’s open enrollment won’t see premium spikes of thousands of dollars per year. It will also allow California to take extra steps to lower cost-sharing and potentially eliminate deductibles for some plans,” said Wright. “The impact of this legislation will be felt for years to come, as Medicare gains more ability to negotiate down the cost of prescription drugs, and more people get health care coverage as a result of lower premiums.”

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