Affordability and Benefits Provisions in California Health Care Reform Measure 2003-2008

Existing Law / Reality Affordability provisions/protections Benefits • Employer-based coverage: NONE • Individual insurance market: NONE • Medi-Cal: “nominal” cost-sharing • Healthy Families: no more than 5% of income, lower under California law • HMOs: medically necessary care, including doctors and hospitals but not Rx • Insurers: doctors OR hospitals; allows limits such as one or two doctor visits, $800 a day for hospital, etc. • Medi-Cal/Healthy Families: medically necessary care, including doctors, hospitals and Rx