Thankful for a Year of Progress on Health Care

Many Californians are thankful for this year’s progress on implementing health reform and improving our health system through new coverage expansions and patient protections. In particular, California will soon open up Medi-Cal to enroll all children regardless of immigration status, capping a year of progress toward a more inclusive health care system.

The Affordable Care Act was a historic step forward, and California has made remarkable progress on implementation, with the fifth highest drop in uninsured residents.  But just as important, California has used the law as a jumping off point for a more inclusive, accessible, and affordable health care system.

This last year California enacted several patient protection bills addressing unfair out-of-pocket costs. The signed legislation—some of it the strongest in the nation—will help prevent out-of-network bills due to inaccurate provider directories, huge cost-sharing for specialty drugs, double deductibles in family plans, as well as extend protections against “junk insurance” to those covered by large employers.

  • SB 137 (Hernandez) will require updated, standardized, and accurate provider directories.  Co-sponsored by California Pan-Ethnic Health Network, Consumers Union, and Health Access California (see separate SB137 fact sheet), SB 137 will address the common insurance industry practice of posting inaccurate, out-of-date, and misleading provider directories.
  • AB 339 (Gordon) will require insurers to cover medically necessary prescription drugs and limit cost-sharing on specialty drugs and other needed medications. The bill ensures coverage for drugs for which there is no therapeutic equivalent; prohibits placing most or all of the drugs to treat a condition on the highest cost tiers of a formulary; requires formularies to be based on clinical guidelines and peer-reviewed scientific evidence; places monthly cap on specialty drug cost sharing; and more (see separate AB339 fact sheet).
  • AB 1305 (Bonta) would ensure an individual patient does not face higher out-of-pocket costs just because they are in family plans, closing a potential loophole in the out-of-pocket maximum protections in the Affordable Care Act (see separate AB1305 fact sheet). The bill would ensure that the $6,600 maximum out-of-pocket cost cap applies to individuals in family plans, not just individual plans.
  • AB 248 (Roger Hernández) will extend consumer protections to ensure large employers do not offer “junk insurance” that does not cover basic benefits. Federal and state law already hold insurance sold to small employers and individuals to a basic standard (60% actuarial value), but under current law insurers are free to sell large employers “junk” plans. When large employers offer such subminimum plans, employees are stuck with thousands of dollars in out-of-pocket costs. If an employee accepts that coverage, even if it is subminimum coverage, the employee is automatically ineligible for premium subsidies through Covered California (see separate AB 248 fact sheet).

These bills close loopholes in Obamacare and address lingering issues, and in fact use the new law as a platform for improved patient protections.

COVERAGE EXPANSION: Due in part to the aggressive outreach and enrollment efforts, California also made historic progress in reducing the number of uninsured, with the fifth largest reduction of the uninsured rate in the nation and millions covered—but we still have an above-average uninsured rate, with more to do.

Along with restoration in the state budget of some key public health programs, California took another significant step this year with the confirmation to cover all income-eligible adults in Medi-Cal with “deferred action” immigration status, and the commitment to extend Medi-Cal cover all children up to 266% of the poverty level regardless of immigration status—another expansion that we must work together to successfully launch this May.

And we will continue the fight for health for all, either at the state level through SB10(Lara), or through various county efforts, building on recent progress in Sacramento, Contra Costa, Monterey, and the CMSP consortium of 35 counties.

REVENUES: Finally, we successfully worked for a new Medicaid waiver that provide new incentive and resources to transform the delivery system, to provide better integration of health and human services, and to have a more inclusive and smarter safety-net.

We also made progress on new revenues to support investments in our health system, through ballot measures and a special legislative session. Building on these efforts, we enter 2016 with a full agenda.

See our 2015 Year in Review for details.