Appropriations Committees Pass Key Health Bills

HEALTH ACCESS UPDATE: Thursday, August 14, 2014 


*        Important health bills advance, including ones sponsored by Health Access California, and head toward floor votes in final two weeks of legislative session.

*       Bills passed by Appropriations Committees today include those to help consumers once they get coverage, with ensuring network adequacy (SB964) and timely access to care (AB2253), avoiding junk coverage (AB2088), putting in place rate review (SB1182) for large employers, getting insurers to track out-of-pocket expenses (SB1176), limiting Medi-Cal estate recovery (SB1124), and accepting foundation money for Medi-Cal renewals (SB18) and more.

        Bills held and stalled for the year include two to create on all-payer claims databases, a bill on hospital community benefits, and a measure codifying Covered California privacy protections.

*        In other news, Health Access’ Beth Abbott appointed by Governor Brown to be director of the revamped Office of the Patient Advocate.


Today, the Appropriations Committee of both the California Senate and Assembly met, and decided the fate of hundreds of bills, including several to provide new consumer protections and oversight to benefit health care consumers.

Over 300 bills in the Senate and over 150 bills in the Assembly were “on suspense,” being evaluated in terms of their cost and fiscal impact, until today, where a portion of them were released, set to go to floor votes in the next two weeks. Bills must pass through final floor votes and the full Legislature by the end of August. If passed, the Governor would have the month of September to sign or veto.

Bills that passed Appropriations Committee today included key bills to ensure network adequacy and timely access to care: SB 964 (Ed Hernandez) would require DMHC to do annual reviews for timely access and network adequacy, separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal and Covered California get timely access to necessary care. AB 2533 (Ammiano) would ensure timely access to necessary care at in-network cost-sharing.

SB 1176 (Steinberg) gives health plans and insurers the responsibility to track out of pocket costs–and reimbursing when patients hit the out-of-pocket maximum.

Another bill, AB 2088 (Hernandez) would extend consumer protections against “junk” insurance to large group market, banning large employers from offering limited benefit plans to their employees, unless the limited benefit plan was supplemental to comprehensive coverage.

Two important Medi-Cal bills also passed.SB 18 (Leno) would have the State accept $6 million from the California Endowment to fund Medi-Cal renewal assistance, and drawing down federal matching funds as well. SB 1124 (Hernandez) would limit Medi-Cal estate recovery to long-term care, so those getting Medi-Cal managed care services would not find that their family home had a claim on it after death.

SOME BILLS HELD: afterNot all bill survived the Appropriations Committee process. Two bills, SB1322(Ed Hernandez) and AB1558(Roger Hernandez) to create versions of an all-payer claims database–to provide more cost transparency in our health system–were held. AB503(Wieckowski) on hospital community benefits was also held, as was SB974(Anderson) to codify Covered California’s privacy protections. These held bills, and others, are stalled for the year.


Many bills did make it through the Appropriations process, and consumers groups are mobilizing in support. These are some of the bills of interest to health care consumers pending for floor votes in the state legislature in the next two weeks:

Ø  Insurance Consumer Protections

NETWORK ADEQUACY OVERSIGHT OF HEALTH PLANS: SB964 (Ed Hernandez) requires the Department of Managed Health Care (DMHC) to do annual reviews for timely access and network adequacy to be done separately for Medi-Cal managed care and the individual market so that consumers in Medi-Cal managed care and Covered California get timely access to necessary care. Sponsored by Health Access California.


PRESCRIPTION DRUG COST SHARING: AB1917 (Gordon): would cap prescription drug co-pays at 1/12 of the annual out-of-pocket limit so that patients with HIV/AIDS, cancer, MS, and other diseases will not be forced to pay high upfront costs for their medication. Consumers would still have the annual out of pocket limit of no more than $6,350 for an individual or $12,700 for a family under the ACA, but the cost of any one drug can’t be more than 1/12 of the annual limit or $530 for a single month’s prescription rather than $6,350 as current law provides. Sponsored by Health Access California.


JUNK INSURANCE FOR LARGE EMPLOYERS: AB2088 (Roger Hernandez) while not banning limited benefit plans, makes them supplemental to comprehensive coverage. California law  allows the sale of “insurance” that provides limited benefits with a minimum actuarial value of less than 60%. This bill extends this consumer protection to large employer coverage, closing a loophole for employers to avoid compliance with the intent of the ACA. Sponsored by Health Access California.


SB1176 (Steinberg) makes the health plan or insurer responsible for tracking out-of-pocket costs for in-network providers, and reimbursing the consumer when they exceed their out-of-pocket limit. SUPPORT.


AB 2533 (Ammiano) would seek to ensure timely access to necessary care at in-network cost sharing. SUPPORT.


SB959 (Ed Hernandez) is the clean-up bill for the individual and small group market reform legislation to implement the ACA enacted in 2012 and 2013. SUPPORT.


SB20 (Ed Hernandez) modifies the individual market open enrollment period for the 2015 policy year to be November 15, 2014-February 15, 2015, so that it is consistent with the dates announced by the federal government exchange. SUPPORT.


SB1034 (Monning) would delete 60 day waiting period for California insurance. California law would not permit any waiting period as a result of a pre-existing condition. Federal law would permit employers to impose a waiting period of as much as 90 days for workers and dependents. SUPPORT.


Ø  Cost/Quality Transparency

SB1182 (Leno) would implement large group rate review for rate increases. It also provides claims data or other detailed data to large purchasers.  SUPPORT.


AB1962 (Skinner) would make transparent what dental-only plans spend, as a percentage of premium, on patient care. It requires specialized dental-only plans to disclose a “medical loss ratios” as for medical coverage. The bill is sponsored by the California Dental Association. SUPPORT.


Ø  Hospital Oversight and Consumer Protections.

SB1094 (Lara) amends existing law on Attorney General oversight of nonprofit hospital mergers and acquisitions. It extends the review period from 60 days to 90 days. It also gives the Attorney General authority to enforce conditions of hospital transactions. This bill is sponsored by the Attorney General. SUPPORT.


SB1276 (Ed Hernandez) updates the Hospital Fair Pricing law (which Health Access California sponsored in 2006) by: defining a reasonable payment plan as monthly payments that are no more than 10% of income after essential living expenses; allowing underinsured individuals with high health costs (over 10% of income) to receive the hospital fair pricing discount even if they receive a discounted rate on their cost sharing from their health plan or insurer. It is being sponsored by Western Center on Law and Poverty based on their experience assisting consumers. SUPPORT.


Ø  Medi-Cal

SB18 (Leno/Hernandez)would have the state Department of Health Care Services accept foundations funds (currently offered by the California Endowment) and get federal matching funds to help provide assistance for Medi-Cal renewals. Sponsored by Health Access California and Western Center on Law and Poverty.


SB1124 (Hernandez) limits Medi-Cal estate recovery. California is one of only ten states that impose estate recovery on more than long term care services, where the state, for those over 55, recovers the cost of all medical care from the estate of an individual after death. This has discouraged some from signing up for Medi-Cal coverage. Co-sponsored by Western Center on Law and Poverty (WCLP) and California Advocates for Nursing Home Reform. SUPPORT.


AB2325 (Speaker Perez) would create a Medi-Cal medical interpreter program. The bill was vetoed last year: this is a re-introduction of that measure. SUPPORT.


Ø  Prevention

SB912 (Mitchell) would eliminate the sunset on the current requirement that vending machines in state buildings include 35% healthy food and drinks. Sponsored by California Pan-Ethnic Health Network. SUPPORT


Congratulations Beth and Welcome Judi!

With ambivalence but great appreciation, we here at Health Access California, wish hearty congratulations to Beth Abbott, just announced by Governor Jerry Brown to soon start as the new director of the Office of the Patient Advocate (OPA).

Beth Abbott will lead a revamped OPA, which continues to be in charge of publishing quality ratings and a report card on health insurers, and will take on new responsibilities collecting, tracking and reporting on data from state health consumer assistance agencies. Health Access also is pleased to announce starting this week our new Director of Policy Research and Communications, Judi Hilman, who had been the founder and executive director of the Utah Health Policy Project for seven years, leading consumer health advocacy and reform work in that state, before coming back home to California. More about Judi down below.

As per California’s new Patient Advocate: Our loss is California consumers’ gain–we are pleased that Beth will take the helm of this newly-revamped state agency, and have full confidence she will make it a meaningful force in improving the experience of consumers who are dealing with health insurance issues. Beth Abbott is one of few people in the state for whom the Patient Advocate is so perfect a title. We are pleased she is taking charge of a restructured Office of the Patient Advocate to make sure it lives up to that title, in making sure consumers get the help they need when picking and dealing with health insurers.

Under the changes in state law, OPA’s major functions include health care quality report cards, with clinical performance and patient experience data for the state’s largest health plans and over 200 affiliated medical groups; compiling and reporting on how state health consumer assistance call centers are (or are not) helping patients, from the Department of Managed Health Care, Department of Insurance, Department of Health Care Services, and Covered California; and the development of model protocols for these call center agencies.

Beth Abbott has been with Health Access for nearly nine years, serving as our Director of Administrative Advocacy since 2006, working on behalf of California consumers before state and federal agencies. She also had been a constant consumer advocate presence at many agencies, including the Department of Managed Health Care (DMHC), the Department of Health Care Services (DHCS), the Department of Insurance (CDI), the Managed Risk Medical Insurance Board (MRMIB), Covered California, and many more. As part of that work, she has been one of 15 designated national health Consumer Representatives advising the National Association of Insurance Commissioners (NAIC) on the implementation of health care and insurance market reforms, since 2010. She also serves on the DMHC’s Financial Solvency Standards Board and other workgroups and task forces.

Among her many contributions, Ms. Abbott co-authored a 2012 Health Access “secret shopper” report on how state health consumer assistance agencies fared when dealing with consumer calls. We applaud Governor Brown’s foresight and courage to bring one of California’s leading patient advocates into his administration. She will be in a unique position to help implement many of her own recommendations on how to improve consumer’s experience in dealing with state health agencies.


She previously served as the Regional Administrator of the Centers for Medicare and Medicaid Services (CMS) that serves the states of California, Arizona, Nevada, Hawaii, and the Far Pacific. She was responsible for the oversight of the Medicare and Medicaid programs, managed care plans, and the quality of care delivered in hospitals and nursing homes. The region serves over 10 million beneficiaries, and has a programmatic budget exceeding $30 billion per year. Before CMS, she worked for the Social Security Administration (SSA) in 17 field and regional offices in Massachusetts, Connecticut, Illinois, Indiana, and throughout California. Ms. Abbott has B.A. in psychology from the University of Redlands and has done graduate work in public administration at the University of Southern California.

Health Access will miss Beth tremendously, from her deep experience working both inside and outside government health agencies, to her doggedness and commitment to consumers, to her humor and her ability to make a strong and forceful point while still leaving you with a smile.

Health Access will continue its advocacy with a new senior staff member, Judi Hilman, our new Director of Policy Research and Communications. A nationally noted health consumer advocate, Judi Hilman has over 15 years of experience working to create and implement robust and financially sustainable solutions to America’s ongoing health care crisis.  Her new position at Health Access is the logical next step in a career dedicated to expanding access to high-quality, affordable health care. Hilman’s previous work at the Utah Health Policy Project (UHPP) exemplifies this commitment.  She founded UHPP in 2006 and served as its executive director until 2013.  UHPP is a nonprofit “think and do tank” that advocates for comprehensive, affordable, high-quality health care coverage for all Utah residents. After leaving UHPP, Hilman served as Chief Advocate and Member Engagement Officer at Arches CO-OP Health Plan in Utah, one of the brand-new cooperative health plans created by the Affordable Care Act to provide creative new models of health coverage oriented around medical homes and re-aligned incentives for providers and patients. Hilman’s leadership in health policy advocacy has been recognized with numerous awards and recognitions.  In 2008, she was selected as one of ten Community Health Leaders by the Robert Wood Johnson Foundation and in 2011 she was named Consumer Advocate of the Year by Families USA. She has also been honored with awards from CMS (federal Centers for Medicare and Medicaid Services), from the Peter Suazo Social Justice Award by the University of Utah College of Social Work, and from Utah Children and the League of Women Voters.

Born in Los Angeles and raised both in California and Israel, Hilman received her BA in history at the University of California at Berkeley, and obtained a Master’s degree in this subject at Cornell University.  She moved to Salt Lake City in 1999, where she quickly became a nationally-recognized expert in the art of advocating for progressive policy reform within highly conservative legislative environments, and in seeking “post-partisan” solutions – for the individual consumer and for the system as a whole – to the problem of rising health care costs.  Hilman has authored and co-edited several publications, including Utah’s Poor: Solutions for Today’s Economy and Making Sense of Utah Medicaid. When not advocating for health policy reform, she can be found extolling the virtues of walkable communities and bike lanes, community supported agriculture, physical fitness, dog rescue, and good cooking.

After years of working with her as a colleague as leaders of state health consumer advocacy coalitions, and admiring what she was able to accomplish in the politically challenging state of Utah, I am thrilled to have Judi join our team to improve California’s health system. Judi brings a wealth of experience and knowledge that will be helpful as we implement and improve upon the Affordable Care Act, embark on a new Medi-Cal waiver, seek to reduce health costs, cover the remaining uninsured, and strive for quality affordable health care for all.

If we are going to lose a Cespedes-level player like Beth Abbott, it’s good that Health Access is improving our team with a senior, Jon Lester-level talent like Judi Hilman. It’s good for Californians that Beth is on the case, to make sure they get quick, responsive, and meaningful help when selecting a plan, or when dealing with an insurer who is causing grief. It’s also good Health Access will have another senior staff member with a lifetime of service joining us to help fulfill our historic role.

Thanks to all! Congratulations, Beth! Welcome, Judi!

Legislature Returns, To Consider Key Health Bills

As the California Legislature came back this week from vacation, several key health consumer protection bills are pending, backed by consumer, community, and health organizations, but actively opposed by health insurers. The bills, set to be considered in these last few weeks of the legislative session, would address the most notable concerns raised by consumers in the first year of implementation of the Affordable Care Act: insurers’ “narrow networks” of providers, and managing out-of-pocket costs.

California has led in expanding coverage under the Affordable Care Act, but we have more to do to make sure that coverage is meaningful for all consumers, once enrolled. Pending state legislation would increase insurance oversight to ensure consumers, once covered, have timely access to care, and without the barrier of undue out-of-pocket costs. We need California legislators to stand with consumers in the face of insurance company opposition to these common sense patient protections.

** Ensuring Network Adequacy and Timely Access to Care:

SB964 (Hernandez): Regulatory Review and Surveys of Network Adequacy/Timely Access

·         SB 964 requires DMHC to conduct *annual* reviews of health plans for timely access and network adequacy separately for Medi-Cal managed care and the individual insurance market, including Covered California plans.

When patients agree to a limited network of providers, the insurers are committing to have a network adequate to provide timely access to care. SB964 will increase oversight and enforcement of insurers so people can get they care they need where and when they need it. Whether “narrow networks” in some Covered California plans, or access issues in Medi-Cal managed care plans, the insurers must meet a minimum standard, and SB964 ensures pro-active monitoring by the regulators.

AB2533 (Ammiano): Ability to Go Out-of-Network  at In-Network Costs If No Timely Access

·         AB2533 would allow a patient who  cannot see a provider within 10 business days (the established timely access standard) to go outside the network for care arranged  by the health plan and pay the same in network cost for care.

This bill provides a real-world remedy for people who can’t get timely access. Insurers promise the networks are big enough to provide access to care in a timely fashion; otherwise, the insurers are making a false claim. AB2533 is crucial for lower-income families inside and outside Covered California who can’t afford out-of-pocket costs for out of network care.

** Helping Consumers Deal With Out of Pocket Costs:

AB1917 (Gordon): Making Prescription Drug Cost Sharing Manageable

·         This bill caps prescription drug co-pays at 1/12 of the individual annual out of pocket maximum, which is $6,350 for the 2014 plan year, a limit that increases annually as health care costs rise.

This bill ensures people with chronic illnesses who depend on high cost life-saving drugs pay no more than $530 up front instead of over $6000, which is current cap. Someone who has MS, HIV, or another chronic illness should not have to pay thousands of dollars up front for life saving prescription drugs. This bill works within the out of pocket maximum limit that is set by the ACA, to ensure consumers aren’t forced to choose between their money and their health when paying for prescription drugs.

SB 1176 (Steinberg): Tracking and Reimbursing Out-Of-Pocket Costs

·         The ACA established out of pocket maximum limits and in California that limit is $6,350 for an individual or $12,700 for a family for the 2014 plan year, a limit that increases annually as health care costs rise. This bill requires insurers to track out of pocket costs paid by consumers and reimburse consumers who go over their out of pocket limit.

This is a practical bill that ensures the out of pocket limit is a meaningful protection, by having the insurer track cost-sharing, and automatically reimburse the patient if they go over the cap. Patients with big medical expenses have enough to deal with, they shouldn’t have to keep all their medical receipts in a shoebox to get the benefit of the out-of-pocket maximum in the Affordable Care Act.

The Newly-Announced 2015 Covered California Rates

Last week, Covered California, the state health insurance marketplace created under the Affordable Care Act with over 1.4 million Californians enrolled, announced their tentative 2015 rates for the health insurance plans they will offer, showing only a modest average 4.2% rate increase.

Here’s the press release, and here’s several news clips from Kaiser Health News, APSacramento Bee, San Francisco Chronicle, LA Times, Orange County RegisterFresno Bee, San Jose Mercury News, Marketwatch and others.

This is a good news announcement, with implications beyond California and beyond health care. For decades, we have worked with Californians facing the worst of the health crisis nationally, from a sky-high uninsured rate to denials of pre-existing conditions to double-digit rate increases year after year. With the Affordable Care Act, we are seeing progress on access and affordability: California has seen the number of uninsured cut in half, and with the news today, the premium rate increase have been cut in half as well.

IMPACT OF RATES FOR CALIFORNIANS: This news means that not only will 1.4 million Californians be able to renew their new Covered California policies, without significant rate hikes; but we are in a good pricing position to enroll many more of the remaining uninsured. Practically, almost 90% of Covered California have affordability subsidies, that will go up in 17 of 19 regions to help deal with the increases. Consumers will also be able to shop around, because they won’t be locked in to one plan or locked out of any because of pre-existing conditions. Because of these rates, less people will go uninsured, live sicker, die younger, and be one emergency from financial ruin. Health insurance is still not cheap or easy–there’s more work to do–but what a improvement, as it is now cheaper and easier than it would have been.

ON PAST PREDICTIONS: This is a rebuke to all the Obamacare naysayers and political opponents who predicted double-digit rate increases. Last year, when Covered California announced competitive rates, below what CBO or their own actuaries had projected, they predicted that rates would skyrocket the next year. The Obamacare haters were once again wrong, as shown by these modest rate increases in the first year where we can do true apples-to-apples comparisons. Those who continue to campaign for the repeal of the ACA, in this state or anywhere in the nation, are increasingly having to deny the facts on the ground here in California–that Obamacare is working and benefitting millions of Californians.

IMPLEMENTING AND IMPROVING: These results are an endorsement of the need for more reform, not less. California took steps to not just implement but improve the ACA to help get us here: an exchange that actively negotiates for the best price and value; the standardization of benefits to encourage competition; early and aggressive steps to do outreach and enrollment.

VIGILANCE ON NETWORKS: Holding the line on premiums and getting people covered is only one step–this needs to be coupled with strong vigilance on ensuring consumers get the value they serve, especially with regard to access to care. After concerns with some insurers “narrow networks,” we advocated and our pleased that legislators and regulators are acting to ensure network adequacy and timely access to care. To ensure adequate networks, both California regulators are stepping up enforcement, with surveys and even new regulations, and key legislation is pending. We are pleased that these rates for products that already reflect broader networks, and that the most problematic network issues from last year–like networks restricted to one county–have been addressed by insurers.

PROGRESS IS POSSIBLE: For years, the number of uninsured and skyrocketing health premiums were seen as intractable problems. But recent surveys and studies, and the new rates announced today, suggest that while these problems are certainly not solved, we are making significant progress using the tools of the Affordable Care Act. California shows progress is possible, and we can’t let up the momentum now.


When some of us were out on summer vacation, two rulings came down regarding Obamacare subsidies provided through Exchanges. One appeals court rejected challenges to the law; but another three-judge appeal court panel split 2-1 in accepting the idea that the federal Exchange is not able to provide subsidies.

Apparently, there was some ambiguous language in the Affordable Care Act, which indicated that those in state-run exchanges would get affordability subsidies, but it wasn’t totally explicit that patients in states using the federal fallback exchange should also have access to these subsidies. Nevermind that is is clearly implied, that the bills was scored and budgeted for subsidies going to all 50 states, that never in the reporting or hearings of the law was there any suggestion that there would be a difference in subsidies between those in state-based exchanges and federally-run exchanges. Two Republican judges took it upon themselves to use a super-literal reading of the text to take money to afford health care from millions of Americans in 36 states.

This would be a “blow to Obamacare,” if it were real. But this challenge isn’t advancing. It’s not just the other appeals panel that rejected the argument; even the conservative members of the Supreme Court, in their deliberations two years ago, assumed that all states would be getting subsidies.

As we stated on Twitter, this has zero, zilch, nada, no impact on California whatsoever, even in the worst case scenario, which ain’t going to happen. Even in that worst-case scenario where this crazy ruling is upheld, California has protected itself by setting up its own exchange, Covered California–its most likely that several more states would set up Exchanges if that were the point. There is no challenge to the subsidies provided for getting Covered California plans–the over 1.2 million Californians getting subsidies in Covered California can rest easy that this will have no impact on their ability to get coverage or subsidies.

We would have hoped that Jon Stewart in covering this would have brought this key point up, but the rest of his coverage on this subject is spot on:

The Not So Narrow Impacts of the Hobby Lobby Decision

Consumer, community, women’s and health organizations expressed disappointment in the Supreme Court decision in the Hobby Lobby case.

It’s very disappointing that the Supreme Court is allowing corporations to determine the health options of their workers, however narrowly tailored the decision. If a corporation provides coverage, it shouldn’t impose the beliefs of its owners onto the health care of its workers. This decision puts an asterisk on how we define health coverage, and thus how we regulate it.

Most Californians will continue to get all the benefits of the Affordable Care Act; the contraception benefit is not struck down, nor any other part of Obamacare: most will continue to get the newly-won right to get birth control without a co-payment. Specific California law also limits the impact of this law, and there’s a bill pending SB1053(Mitchell) in the California legislature that would further reduce its reach.

That said, what is concerning is the health options for those specific workers directly impacted, and the precedent that corporations can assert religious beliefs to avoid implementing key worker and consumer protections, or other health benefits.

Justice Ginsburg was right to ask how a future court might allow a corporation might use an religious reason to not provide coverage for blood transfusions, vaccinations, anti-depressants, or other medical treatments. That’s a precedent that should concern everybody.

Senate Health Committee on deadline day

Senate Health Committee, Chaired by Doctor Ed Hernandez met today and heard the following bills of interest to health advocates. Here’s a report by our Sawait Hezchias-Seyoum:

* Health Access sponsored legislation, AB 2088 (Hernandez) would close a loophole in federal law which allows insurers to sell large employers skinny benefit plans that do not meet ACA requirements. The bill passed out with a vote of 6-2.

* AB 1792 (Gomez), which would require the Employment Development Department to report on receipt of public assistance by employees of California employers, passed out with a vote of 6-1.

* AB 1558 (Hernandez) which would allow create a health care cost and quality database at the University of California, and publish studies on health care cost and quality passed out with a vote of 6-1.

* AB 1759 (Pan) which as amended would require an annual independent assessment of Medi-Cal provider reimbursement rates and their impact on access to care and quality of care in the Medi-Cal program passed out with a vote of 8-0.

Assembly Health Committee takes on Medi-Cal renewals, network adequacy, etc.

The Assembly Health Committee, chaired by Doctor Richard Pan met today and heard several bills of interest to health advocates. Here’s a report by our Sawait Hezchias-Seyoum:

* SB 18 (Hernadez) as amended would accept $6 million in free foundation funds, and then draw down another $6 million in federal funding to help California consumers who are enrolled in Medi-Cal renew their coverage next year. This bill sponsored by Health Access and Western Center on Law and Poverty passed out with 13 votes.

* SB 964 (Hernandez) which as amended would require additional scrutiny of managed care plans that cover Medi-Cal beneficiaries or Covered California enrollees passed out with 14 votes. This Health Access-sponsored bill would increase enforcement for timely access to care and network adequacy standards.

* There was significant back-and-forth debate around SB 1094 (Lara) which as amended would extend the timeframes for the Attorney General review of nonprofit hospital transactions and give the Attorney General authority to enforce the conditions imposed on such transactions without litigation. Proponents and opponents alike were on pins and needles until the very end of the hearing.  Senator Lara argued that SB 1094 (Lara) is an important bill to assure a nonprofit hospital will continue to serve its community after a transaction in which ownership changes. The opposition argued that the bill adds uncertainty in transactions involving the sale or transfer of nonprofit hospitals by allowing the Attorney General to unilaterally impose post-transaction conditions–which Senator Lara clarified was only allowed if a hospital had lied. The bill finally passed out of committee.

* SB 1100 (Hernandez) was scheduled to be heard today, but was pulled by the author at the hearing after the chair requested amendments to narrow the bill considerably.  These amendments were not acceptable to Dr. Hernandez and Health Access, the sponsor. This bill would have applied longstanding California law on continuity of care to individual market coverage, so patients can continue with their provider to finish a course of treatment even if they need to change health plans in open enrollment, and would have provided notice to all Californians with coverage of their right to continuity of care.

* SB 974 (Anderson) which deals with privacy concerns around personal information and the Health Benefits Exchange passed out with 19 votes.

* SB 1052 (Torres) as amended would require the California Health Benefits Exchange to require qualified health plans to post the drug formulary for the qualified health plan on the carrier’s website and would also require insurers (in and outside Covered California) to themselves post their formularies. The bill passed out with 14 votes.

* SB 1182 (Leno) which as amended would implement large group rate review and would require provision of detailed data to large purchasers passed out with 13 votes.

* SB 1276 (Hernandez) which, as amended, would update the existing Fair Hospital Pricing Act  sponsored by Health Access to assure uninsured and underinsured Californians are not overcharged for hospital care, by ensuring patients have the option of a payment plan, passed out with 11 votes.

* SB 1322 (Hernandez) which as amended would create an all-payer database passed out of committee with 13 votes.

* SB 1341 (Mitchell) which as amended would require that the Statewide Automated Welfare System (SAWS) has the ability to make use of the Medi-Cal rules housed in the IT system, CalHEERS, jointly operated by the California Health Benefits Exchange and the Medi-Cal program passed on consent.

Covered California Getting Ready for 2015

Here’s our report on the five-hour Covered California Exchange meeting on Thursday, June 19, as written by our director of administrative advocacy, Elizabeth Abbott:

The board of Covered California continued its evaluation of the 2014 enrollment, outreach, and customer service metrics.  They also revealed their preparations for the 2015 open enrollment period which begins November 15, 2014.  They provided a clear focus on what they would change and what would remain the same in their policy and operations.

Comings and Goings.  The Executive Director and the Covered CA board expressed genuine regret that the Contra Costa Health Plan would not be participating in 2015 as a plan offering.  The Exchange said they truly valued their partnership, but that Contra Costa reluctantly made their decision based on certain provisions and limitations in the federal law.  The CEO of Contra Costa expressed the plan’s hope that their absence from the exchange would only be temporary.   Peter Lee also wished the best to Gabriel Ravel on their legal staff who has been selected by the Department of Managed Health to be their chief counsel.  Peter acknowledged his tremendous work from the beginning in making Covered CA a reality.

Customer Service.  Covered CA was pleased to announce that their Service Center was now meeting and exceeding their customer service goals of 80% of their calls answered within 30 seconds.  They are now performing at the level where they are able to answer 94% of the calls within the first 30 seconds and less than 2% of calls were abandoned as measured in June.  This improved customer service is due principally to the reduction in the volume of calls, but they still recorded more than 205,000 calls in May, and 47,727 calls through June 9.  Covered CA staff also attributed these better customer service metrics to a combination of factors including:  better trained and proficient customer service staff, the fully functioning dedicated call numbers provided for brokers, agents, certified enrollment counselors, and SHOP questions, the shift of some calls to the selected health plans, and greater efficiencies and applying what they had learned during the first open enrollment period.  However, public comments urged increased recruitment of bi-lingual staff, and re-examination of the technological language transfer capacity because when some callers asked to be transferred to a Spanish-speaking customer service representative, they were cut off.

In addition, Covered CA has done extensive research and technical evaluation regarding allowing web-based entities to enroll consumers in plans offered on the exchange.  Although there was significant interest in exploring this alternative, there were concerns about the additional costs, the specific web design and integration, and, in light of the experience during the first open enrollment period, whether the online broker entities would actually be able to reach high numbers of unique, new applicants.  Consumer advocates raised issues regarding web based entities being able to reach those with limited English proficiency, the ability to offer expertise about Medicaid eligibility, and privacy and security concerns.  The staff recommended that Covered CA use the balance of time to investigate these technical problems, choices, and costs and defer this until after the end of the 2015 open enrollment season.

Covered CA noted their accomplishment of completing the training and certifying enrollment support for consumers and applicants.  These numbers totaled 5,919 Certified Enrollment Counselors and 12,376 Certified Insurance Agents.  Both groups had significant representation of assisters who spoke Spanish and several Asian languages.

Analysis of Initial Findings of the 2014 Open Enrollment and Plan Offerings

Covered CA released early analysis of the popularity of enrollment channels and plan selections.  They included:

  • African-Americans were most likely to enroll (60.4%) through a self-service enrollment channel.
  • Asians were most likely to enroll (54%) through a certified insurance agent.
  • Latinos were most likely to enroll using Certified Enrollment Counselors (48.2%) or Plan-based Enrollers (40.6%)
  • However, some public commenters questioned these racial and ethnic differentiations based on their field experience and were anxious for further analysis.
  • The most common plans selected by new enrollees were Anthem Blue Cross (30%), Blue Shield (27%), Health Net (19%), and Kaiser (17%).  Smaller plans were also well represented in several regions.
  • Covered CA board and staff affirmed their plan to incorporate very few changes to the benefit design for the 2015 Open Enrollment Period.
  • The staff were pleased to announce that they have successfully worked out embedding pediatric dental benefits in the medial plan offerings in 2015.
  • They also announced they will offer a family dental package for purchase which goes beyond the federal essential health benefits standards for CA consumers.

Policy Issues for Discussion. . .and A Little Controversy

Covered CA is refining their approaches to consumer assistance and correlating it with “successful enrollment” tallies, efforts to reach hard-to-reach groups, and the costs associated with each.  They are facing the imperative of being able to support their operations based on premium assessments (and not federal grants) which at least have the potential to drive up premiums.  In order to assure the most efficiencies and the largest numbers of successful enrollments, they are planning to adjust and realign the outreach and marketing operations and reimbursement to assisters paid by the Exchange.  Initially, they planned to move toward combining educational and enrollment efforts and reimburse only the most successful entities who exceed a relatively high threshold of signing up consumers.  They are rethinking this reimbursement model to account for the fact that they may want to keep smaller CBOs focused on hard-to-reach applicants.  They have undertaken to revise the timetable for that reimbursement to provide up-front costs for small organizations, and further streamlining administrative requirements.  Comments from consumer advocacy organizations urged further dialogue with their groups to incorporate their field experience and consider further refinements and options.  They also pressed for fewer administrative reporting requirements.  Covered CA will continue the dialogue before adopting entirely new models.

There was a heated discussion regarding the issue of the verification needed to confirm eligibility for a special enrollment period.  Plans are leery of consumers “conveniently” undergoing a life-changing event to enable them to elect coverage to coincide with a sudden onset of a serious illness or accident.  Consumer advocates pushed for as expedited as possible ability to do a systems verification of a life-changing event (e.g. marriage, birth of a baby, loss of a job etc.) and not require the applicant consumer to furnish paper evidence.  They also questioned whether Covered CA had the staffing to examine and analyze all of these paper submissions.  This attestation procedure models what is being done by the federal exchanges run by HHS.  Consumer advocates also pointed out that consumers are attesting to these events under penalty of perjury which should be sufficient deterrent to misrepresenting their change in circumstance.  Legal advocates also argued for this conditional eligibility to remain in place for 90 days according to state law, while health plans felt 30 days would be more than enough time.  The board voted to explore these possibilities with further research, with only board member Paul Frears showing flexibility to a broader standard or proof, based on his experience with the Pacific Business Group on Health.

The final controversial topic touched on is the ballot initiative proposed for the November ballot that will give additional authority over rate review to the Insurance Commissioner.  There remained many unanswered questions regarding what that rate review authority, if approved by the voters, would do to the timing for negotiations between Covered CA and the qualified health plans.  There are further discussions planned to work out specific plans and timelines if the measure passes.

There is no Covered CA board meeting planned for July, but they will resume their monthly schedule in August.