Health Committees Vote….

This week we had key policy committee hearings, in advance of the end-of-the-month deadlines to pass bills.

Yesterday, in the California Assembly Health Committee, numerous key bills advanced.

Surprise Bills: Our sponsored legislation, AB533(Bonta) passed on a 17-0 vote, to prevent consumers from getting out-of-network bills when going to a in-network hospital or facility. Even when patients do the right thing and make sure to go to an in-network facility, these “surprise bills” can amount to hundreds if not thousands of dollars and put a family’s finances at risk–if not prevent lower-income patients from getting needed care. Broad support for the bill came from consumer groups like Consumers Union, labor groups, and insurers. Assemblyman Bonta recognized that all stakeholders agreed with the goal of the legislation, and promised to work with the physician groups that raised concerns, to work on an independent dispute resolution process to ensure a fair payment between the insurer and the non-contracting physician. Committee members appreciated the attempt to improve the bill, but acknowledged the need to get the consumer out of the middle of that dispute.

Other legislative updates: Other good bills passed, including AB1231(Wood) on ensuring access to specialty care in Medi-Cal through nonmedical transportation; AB176(Bonta) to get health data to be collected to capture differences within the Asian and Pacific Islander community; and AB1396(Bonta) a companion bill to a tobacco tax proposal to ensure dollars go to increase Medi-Cal access through increased provider rates.

AB68(Waldron) to provide for better access to epilepsy drugs, proceeded after being amended to not undo the Medi-Cal formulary. Another bill, AB1425(Allen) on health reimbursement accounts for small group coverage, did not proceed, opposed by both Health Access and many insurers. As Chairman Bonta noted, the bill did note fit within the regulatory regime of the Affordable Care Act, and would have conflicted with existing rating rules for small group coverage.

Prescription Drug Cost Transparency: The biggest debate was on AB463(Chiu) to get pharmaceutical manufacturers to disclose more information about the cost of developing drugs that are now costing literally thousands of dollars–including Solvaldi, the $1,000/pill Hep-C medication where the full regime is over $80,000. Assemblyman Chiu noted the broad “strange bedfellows” coalition who testified in support (leading off with Health Access), including consumer groups and insurers, nurses and hospitals, labor and Chambers of Commerce. The drug companies and allied groups were in force in opposition, raising concerns about the practicality or wisdom of revealing such information, and that some information was duplicative with already disclosed data. Many committee members spoke; some raised question about whether such disclosure requirements would discourage the development of such life-saving drugs; or how the information would be used. Assemblyman Wood called the bill “Battle of Titans.” Given the questions, Assemblyman Chiu asked for the bill to be put over until next week to give him time to possible amend the bill to address some of the issues raised.

On the same theme, today, the California Senate Health Committee, chaired by Senator Ed Hernandez, passed key transparency bills to better disclose and reveal the cost drivers in our health system, which should be important tools to reduce cost, improve quality and advance equity. Here are some reactions from Health Access, the statewide health care consumer advocacy coalition.

Cost and Quality Database: The Senator Health Committee on Wednesday passed SB26(Hernandez) to create a database of payments in our health system to better understand and address issues of cost, quality, and equity. “In our health system it’s very hard to find out how much a treatment actually costs, the quality of the care provided, or the relationship between the two. California needs more transparency in our health system, like this database, as a step toward additional reforms to minimize costs, improve quality, and reduce disparities.” said Anthony Wright, executive director, Health Access California, the statewide health care consumer advocacy coalition. “This step won’t solve all the issues in our health system, but having the data available and usable for purchasers, policymakers, and patients, could be a gamechanger like it has been in other fields from finance to politics to baseball.”

Large Group Rate Review: The Committee also passed SB546(Leno), that would extend rate review to large group health coverage. While amendments today removed “prior approval” rate regulation, the bill would still require important disclosures and require insurers to publicly justify their rates. “Under this bill, insurers offered by large employers would have to justify above-average rate increases. With overall health care costs slowing, it’s important to ask why many premiums are still going up greater than the rate of inflation in California.” said Wright. “While the Afforadable Care Act took important steps, we need greater transparency and follow-up reforms to really get a handle on health costs, and we urge state legislators to take this next step.”

Both bills move on to Senate Appropriations Committee.

Medi-Cal Rates: On the effort to restore and improve Medi-Cal rates, AB243(Hernandez) passed with broad health industry support on a bipartisan basis. A related bill, to raise the tobacco tax by $2 where much of the revenue would be dedicated to Medi-Cal, SB591(Pan), also passed earlier in the day in the Senate Government and Finance Committee.

Next week is the last week for committee hearings before the deadline.

The Covered California board met on April 16, the first meeting for new board members Marty Morgenstern and Genoveva Islas.  Meeting materials for the April 16 meeting are available here:


Dr. Robert K. Ross, President and CEO of the California Endowment, is celebrated for his contributions as an outgoing Covered CA Board member, along with Kim Belshe and Susan Kennedy, at a post-board meeting reception.

Cost Sharing on Specialty Prescription Drugs

The most contentious issue at the Covered California board meeting was the one that was postponed, on how to design cost-sharing for certain high-cost medications. Covered California has been exploring opportunities to help consumers access expensive specialty drugs that are usually placed on the fourth tier of a pharmacy benefit formulary. Specialty drugs treat conditions such as HIV/AIDS, Hepatitis C, MS, and rheumatoid arthritis. The cost-sharing for some of these drugs can force consumers to shoulder the burden of spending the equivalent of their annual out-of-pocket maximum ($6350) for a single month’s prescription for a single drug.

Health Access was part of Covered California’s Specialty Drug Workgroup, which explored how drug benefit design impacts consumer access to specialty drugs and adherence with drug regimens. The workgroup helped to inform Covered California’s approach to addressing issues around affordability and access. As a result, the Covered California Board, at its March meeting, adopted policy changes improving the transparency of drug formularies and requiring the placement of some high cost drugs on lower benefit tiers. These changes offer improvements for consumers, but advocates are still concerned about the high cost-sharing for these drugs.

Why is cost-sharing for specialty drugs important to consumers? Almost 90% of individuals and families enrolled in Covered California are below 400% FPL ($48,000 for a single individual or $97,000 for a family of four). Asking Californians living on such modest incomes to spend hundreds or even thousands of dollars in a single month for medication is untenable. An ample body of peer-reviewed literature on medication adherence confirms what common sense already told us: if cost sharing is too high, patients will not fill the prescription, they will will skip doses, they will cut pills in half, or otherwise fail to take their prescriptions as prescribed.

A cap, but how much? Instituting a cap on the cost-sharing for specialty drugs can help consumers to manage these high costs and access the drugs they need. In considering a cap, Covered California is trying to balance helping consumers get the right care without undue financial barriers for those with particular health conditions while assuring overall affordability of health premiums (especially given that drug costs are expected to become a larger component of the total cost of health care.)

Covered California staff initially recommended placing a $500 cap on cost-sharing for specialty drugs on most metal tiers ($200 cap for platinum tier, recognizing that consumers pay higher premiums for the platinum tier, and for the low-income Silver tier). Health Access and other consumer advocates support having a cap, but believe $500 per prescription is too high for low- and middle-income consumers. A letter of six consumer groups made that case earlier this week, as did another letter by Insurance Commissioner Dave Jones. Covered California will continue exploring whether a lower cap can be instituted and we hope the Board will be able to take action at its May meeting.

Special Enrollment update

Covered California’s open enrollment period ended on February 15. We are now in the Special Enrollment Period (SEP), which allows people to enroll off season if they meet qualifying criteria such as marriage, loss of insurance, birth, and income changes that result in the loss of other coverage. For consumers who did not realize there was a tax penalty in 2014 or learned they may face a penalty in 2015, there is a limited-time only qualifying event to allow these consumers to enroll in Covered California by April 30, 2015. Consumers are always able to apply for Medi-Cal throughout the year. For more information about special enrollment and the full list of qualifying life events, visit the Covered California website at:

From February 23-April 12, close to 75,000 people enrolled through special enrollment. Of these individuals, 25,000 enrolled due to losing Medi-Cal coverage, and 22,000 enrolled because of a qualifying life event.

1095-A Update

1095-A forms are reports that Covered California sends to consumers summarizing the subsidies they received through Covered CA. These forms are needed to file taxes. Some of the 1095-A forms sent to consumers were incorrect, so Covered California sent revised/corrected forms. Because this is the first year taxpayers are required to disclose whether they have health coverage and report subsidies received on their federal tax forms, the IRS is allowing, but not requiring, consumers to amend their taxes if doing so works to their benefit.

2015 Quality Rating System (QRS) Update

Jeff Rideout, Covered California’s Senior Medical Advisory, gave an update on their quality rating system. Covered California has worked to provide transparency not just on price, but also on quality, so consumers can make choices based on both cost and quality.

The federal government will produce a quality rating system in 2016. Covered California has been posting minimal quality data the past couple years, from the basic Consumer Assessment of Healthcare Providers and Systems survey of consumers (CAHPS). The CAHPS survey measures consumer satisfaction with access to care (getting needed care, getting needed care quickly), doctors and care (rating of all health care, personal doctor, and specialist), and plan service (customer service and overall rating of health plan).

So far, the data available is based on historical performance of commercial and Medicare plans. Covered CA will soon have information on the experience of Covered CA enrollees available. California is the only state-based marketplace collecting and publicly reporting QRS information, which will allow enrollees to use this information to make thoughtful plan choices. Going forward, the survey will be done in multiple languages and CMS is beta testing a question about language and cultural competency.

Advocates encouraged Covered California to incorporate into the quality rating system the ability to stratify quality rating data by language, race/ethnicity, and income, which would help us better understand whether health plans are addressing the needs of vulnerable communities.

For more information about the QRS, see the slides in the Executive Director’s report, available here:’s%20Report_April%2016,%202015.pdf


Essential community provider (ECP) status and access to care in vulnerable communities

An Essential Community Provider (ECP) is a health care provider that serves high-risk, special needs, and underserved individuals. Covered California wants to ensure that enrollees living in underserved communities by making sure provider networks match where enrollees live by zip code. Using enrollee data, Covered California has been able to identify the zip codes of the highest concentration of Covered California enrollees and map access to primary care, community clinics, health services, clean water, grocery stores, etc. This information can help link vulnerable community zip codes to crucial services. Covered California is also using this information to work with health plans to improve provider networks in these communities.

Advocates encouraged Covered CA to look at other social determinates of health, such as race, ethnicity, language spoken, and other factors, because this information can help Covered California to play an important role in facilitating provider capacity in underserved areas. For more information, see slides here:’s%20Report_April%2016,%202015.pdf

Health Access is pleased to see progress toward mapping health-related indicators at the zip code level. Income is only one social determinant of health. Race, ethnicity, language spoken, and other factors are considered. CC can play an important role in supporting and building provider capacity in underserved areas. 

New Guidelines for Navigator Grants

The Covered CA board approved new guidelines for navigator grants. There will be no changes to entities eligible to participate in the Navigator Program. They are moving to a block grant model with payments made every 2 months. The block grants will allow organizations to better plan their own budget and staffing needs. This approach also recognizes the work of not just enrollment but outreach, education, and retention. The new grant model will hold organizations accountable through performance thresholds for new enrollments and renewals, which will help to determine future funding level and continued participation. The navigator grant will also be administered through a three-year contract term. Existing grantees will need to re-apply, and applications will be available next week. Covered California is looking for organizations that have an existing presence and established, trusted relationship with consumers in their community. They anticipate awarding grants in the amount of $50,000-$500,000.


The board took action on regulations relating to Certified Application Enrollment Counselor and Individual Eligibility and Enrollment. Information about these regulations can be found here:

The meeting concluded with a lovely reception honoring outgoing board members Kimberly Belshé and Dr. Robert Ross and welcoming new board members Marty Morgenstern and Genoveva Islas.


Senate and Assembly Health Committee Hearings Week of April 17: Several Key Health Consumer Bills Move Forward

Yesterday, the California Senate Health Committee convened to hear several bills, including three of prime importance to health care advocates.


SB 4 (Lara) on Health4All, would extend Medi-Cal to the remaining undocumented uninsured under 138% of the federal poverty level for adults (annual income of $27,724 based on a family of 3) and 261% FPL for kids ($52,345 for a family of 3) and allow Californians otherwise excluded because of immigration status to buy coverage through Covered California—but using their own money. This bill passed out of committee with a vote of 7-0. Beatriz Sanchez provided an emotional testimony that brought many in the room to tears as she talked about her mother’s death from diabetes and how she could have been helped by SB 4(Lara). Community activist and Registered Nurse Akiko Aspillaga shared how she grew up without access to health care and watched her mother self-medicate by drinking Tylenol whenever she was sick.  Her mother’s refusal to seek medical treatment at the nearest emergency room for more serious health issues was based on fear of debt. Akiko Aspillaga closed by urging the committee to set an example for the nation by passing SB4 (#Health4All).

As part of his testimony Gabriel Aguilar shared that six years ago he was diagnosed with diabetes, and 1.5 years ago he received notice about a potentially cancerous tumor.  With tears in his eyes and in his translator’s as well, Mr. Aguilar added that he has yet to get treatment for his condition.

After providing supporting comments, Senator Hernández and Senator Wolk asked to be added on as co-authors. Senator Hernández noted that it was extremely rare for him to add on as a co-author on any bill, a testament to Senator Lara’s work on the bill.  Health Access, California Immigrant Policy Center (CIPC), United Way, Consumers Union, California Medical Association, and a slew of partner organizations also testified in support. No one testified in opposition.

SB 24 (Hill), on e-cigarettes: Health Access opposed this bill on the basis that it would treat e-cigarettes somewhat differently than other tobacco products–despite evidence that e-cigarettes have much the same negative effect. This bill nonetheless passed out of committee with a vote of 7-0.  Health Access, along with many others, testified in opposition, unless the author amended the bill to treat e-cigarettes in the same manner as other tobacco products. Some Senators shared concerns with the definition of tobacco in the bill, but stated they would support the bill moving forward at this point, seeing what further negotiations might yield.


SB 137 (Hernandez) on provider directories, which is sponsored by Health Access, Consumers Union and CPEHN, would set standards for provider directories and establish more oversight on accuracy so people know whether their doctor and hospital are in network when they shop for coverage, change coverage, or try to use their coverage to get care. This bill passed out with a vote of 8-0. Several organizations, including CPEHN, Health Underwriters Association, CSEA, American Cancer Society and the Southeast Asian Resource Action Center, echoed their support.

On Tuesday, April 14th, the Assembly Health Committee heard AB 366 (Bonta) on Medi-Cal Provider Reimbursement Rates which would restore Medi-Cal provider reimbursement rates from the previous budget cut in the first year, and bring Medi-Cal rates up to Medicare levels in future year. This bill passed out of committee with a vote of 16-0.  The Assembly Health Committee also heard AB 635 (Atkins) on Medi-Cal Interpretation Services. This would require the Department of Health Care Services to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services (except sign language interpretation services) to Medi-Cal beneficiaries who are limited English proficient. This bill got out of committee with a vote of 16-0.

More to Come…

  • Remember to check out our Health Bill Matrix for regular updates on bills sponsored or supported (or opposed) by Health Access.
  • Also check out our Health Action Calendar to follow what’s happening when at the State Capitol–and how you can help support legislation and appropriations to benefit California’s health care consumers.

Spotlight on County Efforts to Win #Health4All


Thursday, April 9th, 2015



* SB4(Lara) included in key immigrant rights package endorsed by CA legislative leadership, including Senate President Pro Tem De Leon and Assembly Speaker Atkins, as well as by Latino Legislative Caucus. Bill, to be heard as early as next Wednesday, April 15th, in Senate Health Committee, would expand Medi-Cal to income-eligible Californians regardless of immigration status, and also get federal waiver to allow all to buy coverage with their own money in Covered California.

* FRESNO County Board of Supervisors voted Tuesday, 3-2, to continue a revamped county indigent care program for undocumented residents, allocating $5 million for specialty care, as per a bill last year to provide such flexibility.

* Other counties moving forward as well (as shown in a recent Health Access report on county indigent care programs): Sacramento County considering restoring programs cut in 2009, weighing options in a recent workshop by Board of Supervisors. 

* WEBINAR TODAY APRIL 9TH at 11AM ON COUNTY INDIGENT HEALTH CARE: Register for this overview of Health Access’ recent report on “Reorienting the Safety-Net for the Remaining Uninsured: County Indigent Care Programs After the ACA.”

* NEW COUNTY PROFILE RELEASED TODAY on lessons from Alameda County’s Measure AA campaign last year, which extended a 1/2-cent sales tax to fund the county health care safety-net.

   Be a Member of Health Access To Help CA Advance to #Health4All This Year!
   Read Our Health Access Blog for More Updates; Also Follow Us on Facebook!
   Read Real-Time Updates on ACA Implementation on Twitter @HealthAccess!


This past week provided new momentum to the effort to ensure care for all Californians regardless of immigration status, at both the state and county level.

CALIFORNIA: On Tuesday, key California legislative leaders, including Senate President Pro Tem Kevin De Leon and Assembly Speaker Toni Atkins, announced their support for a package of ten immigrant rights bills, including the #Health4All measure SB4 (Lara).

The bill, which came out with new amendments earlier this week, would expand Medi-Cal coverage for income-eligibility Californians regardless of coverage, and seek a federal waiver to allow all Californians to purchase in Covered California. the state’s marketplace or exchange under the Affordable Care Act. The bill would cost a fraction of last year’s similar SB1005 proposal, both because it focuses financial help on lower-income folks eligible for Medi-Cal (while allowing those with higher incomes to buy into Covered California with their own money, unsubsidized), and because part of this population is expected to get covered when the President’s executive order on immigration is upheld in the courts.

Citing the significant contribute of immigrants to the state’s history, California legislators urged federal lawmakers to undertake immigration reform, but in the absence of such movement, they vowed to continue state efforts to integrate and include undocumented immigrants into California life. They made the point that California’s health system is stronger when everyone, regardless of immigration status, has access to affordable care. They said that just as roads are safer if all drivers can be licensed and insured, similarly our health system is stronger if everyone has access to primary and preventive care, and not subject to the financial insecurity of being uninsured.

In addition to this package of immigration bills that have legislative leader backing, SB4(Lara) also is included on the priority bill list for the 22-member California Latino Legislative Caucus, which was announced on Wednesday. This gives further momentum for this proposal, which may be heard as early as next week on April 15th in Senate Health Committee.

FRESNO COUNTY: Also this Tuesday, the Fresno County Board of Supervisors voted 3-2 to continue a revamped county indigent care program, by allocating $5.6 million to provide specialty care for the remaining uninsured otherwise excluded from Medi-Cal and other programs.

Fresno Supervisors Brian Pacheco, Buddy Mendes and Henry R. Perea voted in favor of the staff recommendation. Supervisors Debbie Poochigian and Andreas Borgeas voted in opposition. This was the culmination of nearly two years of debate and discussion, which almost led to Fresno being the only county in the state to roll back eligibility in health coverage since the Affordable Care Act was passed: the county had successfully sued to get out from a legal injunction to provide care to the undocumented, and even voted in late 2014 to dramatically reduce its indigent care program, pending further negotiations. However, at the end of this sometimes contentious debate, Fresno voted Tuesday to continue to provide at least some basic health care to all their indigent residents.

Filling in between the primary care provided by some community clinics, and the hospital emergency room services already offered, the County is allocating $5 million made available through a recent law, AB2731(Perea), to provide the County some budget flexibility. If spent on needed indigent health care, the existing state safety-net funding stream, even under the AB85 reallocation, should reimburse that amount into the future. Advocates saw Fresno’s action as not just a lifeline for Fresno families directly impacted, but is an important indicator for inclusion that crosses county lines. The fact that Fresno is continuing their decades-long commitment to provide indigent care—even in a different way—helps build momentum for a statewide solution.

Fresno County thus continues to be one of 10 counties that provides non-emergency care to the undocumented, as shown in a recent Health Access report.

SACRAMENTO COUNTY: As the report indicates, while about ten counties report serving undocumented Californians (although in different ways), more are looking at their options. Three counties that used to provides services to undocumented Californians but stopped during the recession in 2009–Contra Costs, Sacramento, and Yolo–are all considering restoring such services.

Most recently, the Sacramento Board of Supervisors held a workshop weighing different options for providing such care, and over 500 community leaders and members came to show their support for #Health4All. While no decisions were made, at the end of the workshop, Board of Supervisors Chair Phil Serna and newly elected Supervisor Patrick Kennedy both indicated their strong support for providing health care services for the remaining uninsured including the undocumented. Recognizing the “improved situation of the county from 2009 but continued budget demands, Supervisor Don Nottoli also indicated that “we should craft something to help fill the gap.” The Board directed staff to further work up proposals over the next months.

Both Sacramento and other counties are weighing these decisions this spring, in time for new policies to be adopted along with their county budgets that start July 1, 2015.

NEW PAPER TODAY ON ALAMEDA’S MEASURE AA CAMPAIGN: With all the interest in county-based health coverage, Health Access is releasing the first in a series of “profiles in county coverage” today. This first paper, “Winning Revenues for the Remaining Uninsured” focuses on lessons learned from the Measure AA campaign in Alameda County, which passed by 75% of the vote last June to extend a 1/2-cent sales tax to support the county safety-net there.

WEBINAR TODAY ON COUNTY INDIGENT CARE PROGRAMS: Health Access and allied organziations reported on all these developments in Fresno, Sacramento, Los Angeles, Contra Costa, Alameda and other counties on a California Endowment webinar this past Thursday, to present on Health Access’ recent report, “Reorienting the Safety-Net for the Remaining Uninsured: Findings from a Follow-Up Survey of County Indigent Health Programs After the Affordable Care Act.”. The webinar slideshow is online, as is a recording of the presentation.

Not Just Bills: Legislative Packages This Year!

Health Access is pleased to sponsor a legislative package this year of five bills on preventing unfair out-of-pocket costs for consumers. The first of those, SB248 by Assemblyman Roger Hernandez, to end “junk coverage” offered by large employers, passed out of Assembly Health Committee this Tuesday. The others will be up in the next couple of weeks, and we’ll report on more of them as a package next week.

There’s other important legislative packages that were unveiled this week.

Health Access was pleased to be part of the unveiling of an important immigrant rights legislative pacakage. Under the banner “Immigrants Shape California,” legislative leaders talked about the proud history of immigrants contributing to the Golden State, and urged support for federal comprehensive immigration reform. In the absence of such action, they signaled support for 10 bills to provide greater inclusion and protection for immigrant communities–including SB4(Lara) to expand health coverage.

SB4(Lara) was also included in the California Latino Legislative Caucus’ priority bill list released on Wednesday. The list include combating climate change, making voting registration easier, and other efforts, and it was good to see health coverage on the list.

Finally, Health Access is proud to be part of the Save Lives California, and supporting a package of bills to prevent tobacco use, which will save lives and reduce health care costs for the entire system. One bill, SB140(Leno), to regulate e-cigarettes as tobacco, passed out of Senate Health Committee yesterday. Other bills were presented at a press conference with Senators Pan, Hernandez, and Leno, and Assemblymembers Bonta and Thurmond. In this video, the press conference starts at the 19 minute mark:

Health Access has often supported tobacco taxes, like SB591(Pan), to help reduce youth smoking–especially when some of the revenues generated would go to increased access in Medi-Cal, as is the case in AB1396(Bonta). This year, Health Access is pleased to join other public health and health provider organizations in supporting bills like the e-cigarette regulation, and even AB768(Thurmond), which would ban smokeless tobacco in Major League ballparks, preventing youth from seeing ballplayers use the substance. Health Access is supporting these public health measures, which will also make a beneficial impact on reducing health care costs and improving our health system overall.

Big Day for #Health4All, in both Fresno and California…

Tuesday provided huge momentum to the effort to ensure care for all Californians regardless of immigration status.

CA LEGISLATIVE LEADERS ENDORSE IMMIGRANT RIGHTS PACKAGE INCLUDING SB4(LARA) HEALTH EXPANSION: First, key legislative leaders, including Senate President Pro Tem Kevin De Leon and Assembly Speaker Toni Atkins announced their support for a package of immigrant rights bills, including the #Health4All measure SB4 (Lara), which came out with new amendments today, and which may be heard as early as next week on April 15th in Senate Health Committee.

Legislators made the point that California’s health system is stronger when everyone, regardless of immigration status, has access to affordable care. Today we are seeing momentum at both the county and statewide level, to making sure all Californians get the care they need, to the benefit f the health system we all rely on. Just as our communities and economy benefit if all children can go to school, and our roads are safer if all drivers can be licensed and insured, our health system is stronger if everyone has access to primary and preventive care, and not subject to the financial insecurity of being uninsured. Immigrants are a crucial part of our economy and society, they should be part of our health system as well.

FRESNO COUNTY BOARD OF SUPERVISORS VOTE 3-2 TO CONTINUE REVAMPED INDIGENT CARE PROGRAM. At the same time, Fresno County Board of Supervisors allocated $5 million for a revamped county indigent care program, to provide specialty care for the remaining uninsured otherwise excluded from Medi-Cal and other programs. This was the culmination of nearly two years of debate and discussion, which almost led to Fresno being the only county in the state to roll back eligibility in health coverage since the Affordable Care Act was passed. With this vote, Fresno County continues to provide at least some basic health care to all their indigent residents, and continues to be one of 10 counties that provides non-emergency care to the undocumented, as documented in a recent Health Access report:

Fresno’s action is a lifeline not just for the Fresno families directly impacted, but is an important indicator for inclusion that crosses county lines. Fresno was the only county that was considering rolling back eligibility in their indigent care program. The fact that Fresno is continuing their decades-long commitment to provide indigent care—even in a different way—helps build momentum for a statewide solution. We hope that this Fresno program becomes a bridge to a statewide solution like SB4(Lara), which would expand Medi-Cal without regard to immigration status.

These policy efforts required some upfront investments but are fiscally prudent, taking advantage of existing resources spent on emergency services and existing funding streams. It is more efficient and effective to cover primary and preventive care rather than more costly emergency care. Both the movements for health reform and immigrant rights have made a lot of progress in recent years, and we have new momentum this week for this next important step.


Assembly Health Committee Hearing April 7: Several Key Health Consumer Bills Move Forward

Yesterday the California Assembly Committee on Health passed a bevy of bills, most with wide margins. Highlighted below are those sponsored or supported by Health Access California.

  • AB248 Health Insurance: Minimum Value-Large Group Market Policies (Hernández), sponsored by Health Access California, prohibits the sale of subminimum coverage by insurers to large employers. Such “junk” plans sometimes don’t even cover doctor or hospital visits, and put workers in a double bind: leaving workers with unmanageable costs for uncovered care; and because they took up that coverage, they become ineligible for premium subsidies for more comprehensive insurance through Covered California. See our fact sheet and sample support letter. This passed without much fanfare 12-2 with 4 absent or not voting following testimony by Beth Capell (for Health Access), Sara Flocks of CLF, and Michelle Cabrera of SEIU. Committee Chair Rob Bonta presented the legislation for bill author Roger Hernández, who was detained in another committee.
  • AB389 Hospitals: Language Assistance Services (Chau). This CPEHN (California Pan-Ethnic Health Network)-sponsored bill requires that general acute care hospitals provide their language assistance policies to the Department of Public Health and Office of Statewide Health Planning and Development (OSHPD) on an annual basis and also requires the hospitals, DPH, and OSHPD to post the policies on the internet. This passed 18-0.
  • AB763 Medi-Cal Program for Aged and Disabled Persons (Burke and Bonilla) increases the amount of income that is disregarded in calculating eligibility for Medi-Cal, thus effectively raising the eligibility level to 138% of the federal poverty level—the same level as other eligible adults. Sponsored by Western Center on Law and Poverty, this bill passes 16-0, with a much moved Assembly Member Walden offering to co-author right on the spot.

Also worth noting is AB72 Medi-Cal: Demonstration Project (Bonta and Atkins) Per tradition, this passed onto the next stage, though void of substance (a spot bill or placeholder), and this is for the sake of aligning state statutes with the waiver as negotiations with the federal CMS officials are complete by late summer or fall. For those not that well acquainted with the state’s waiver proposal, the bill analysis provides a useful and concise summary.

TODAY: the Senate Health Committee, chaired by Senator Ed Hernandez, will take up SB140 (Leno) which would change the definition of tobacco to include e-cigarettes. Senator Wolk’s bill on end of life treatment and Senator Pan’s bill on vaccinations will also be up for consideration by the Senate Health Committee today.

Click here for our current matrix and guide to health consumer legislation. Find more tools for Health Access-sponsored bills here–be sure to check back for regular updates.

Legislature Reconvenes: Big Committee Votes Up in April

HEALTH ACCESS ALERT: Monday, April 6, 2015


* Key bills sponsored by Health Access California would prevent unfair out-of-pocket costs for consumers, including SB137(E. Hernandez) to ensure accurate provider directories; AB248(R. Hernandez) to prevent substandard employer coverage; AB339(Gordon) on limiting extreme cost sharing for specialty drugs; AB533(Bonta) to prevent surprise out-of-network provider bills from in-network facilities; and AB1305(Bonta) to limit individual deductibles in family coverage. SUPPORT LETTERS DUE ASAP.

* Bill List available on Health Access’ legislative portal, including other key priority support bills like SB4(Lara), to cover Californians without regard to immigration status, and several bills to oppose.

* WEBINAR THIS THURSDAY APRIL 9TH at 11AM ON COUNTY INDIGENT HEALTH CARE: Register for this overview of Health Access’ recent report on “Reorienting the Safety-Net for the Remaining Uninsured: County Indigent Care Programs After the ACA.”


The Legislature reconvenes today after Spring break, with many key health bills up for committee hearings and votes through the end of April. As California continues to implement and improve upon the Affordable Care Act, legislators will consider patient protections to prevent consumers from facing unfair out-of-pocket costs, and other key health reforms.

The beginning of May is the deadline for legislation to pass out of policy committees, and the health committees will be very busy with bills this week through the end of the month.

THIS WEEK: This Tuesday, Assembly Health Committee, chaired by Assemblymember Rob Bonta, will meet to discuss many bills, including AB248 (Hernandez), which is a Health Access sponsored bill which would prohibit sale of subminimum coverage by insurers to large employers. Another bill of interest is AB389 (Chau), sponsored by the California Pan-Ethnic Health Network, which would require a general acute care hospital to post its policy for providing language assistance services to limited-English proficient (LEP) individuals on their website. This bill would also require hospitals to submit electronically their language assistance plans to the Office of Statewide Health Planning and Development (OSHPD) and would require both OSHPD and the Department of Public Health (DPH) to post the hospital language assistance policies on their website. The committee will also discuss AB763 (Burke) which would raise the income level of the Aged and Disabled Medi-Cal program (A&D program) to 138% FPL, creating a “brightline” of income eligibility and parity for elderly and disabled Medi-Cal beneficiaries with other adults.

On Wednesday, the Senate Health Committee, chaired by Senator Ed Hernandez, will meet to take up SB140 (Leno) which would change the definition of tobacco to include e-cigarettes. Senator Wolk’s bill on end of life treatment and Senator Pan’s bill on vaccinations will also be up for consideration by the Senate Health Committee on Wednesday.

For more information on other bills of interest to health care advocates, including upcoming hearing dates, please view our Health Access Bill Matrix at the following link: 

PREVENTING UNFAIR OUT-OF-POCKET COSTS: A particular focus for legislators and consumer advocates this year is out-of-pocket costs. Some practices by providers and health insurers unfairly burden patients with unmanageable cost-sharing, interfering with access to care people need.

As the statewide health care consumer advocacy coalition, Health Access California is sponsoring a package of bill that protect covered patients from unfair charges. For many patients, going out-of-network is prohibitively expensive. Two bills will prevent people from racking up out-of-network bills unwittingly: SB137 to create better standards for provider directories so folks know which doctors are in-network and which are not; another, AB533, to prevent out-of-network charges when a patient goes to an in-network hospital, lab or imaging center. Both are up next week in committee–meaning letters of support are due early this week.

Other bills include follow-up legislation from last year, AB339, which places limits on cost-sharing tied to specialty drugs, and another (AB248 mentioned above) which prevents large employers from offering substandard or ‘junk’ coverage that leaves workers exposed to most of the cost of care. A final bill, AB1305, would ensure that individual patients would not have to pay more than their out-of-pocket maximum, even if they are in a family plan.

Here is a list of the Health Access California sponsored bills that deal directly with the costs consumers directly bear:

SB137 (E. Hernández) AccurateProvider Directories: Standardizes provider directories and has more oversight on accuracy so people know whether their doctor and hospital are in network when they shop for coverage, when they change, or when they try to use their coverage to get care. Co-sponsored with Consumers Union and CPEHN.

AB248 (R. Hernández) Minimum Value Coverage: Prohibits sale of subminimum coverage by insurers to large employers. Such plans put workers in a double bind: with unmanageable costs for uncovered care ; and because they took up that coverage, they are automatically ineligible for premium subsidies through Covered California.

AB339 (Gordon) Prescription Drug Cost Sharing: Requires insurers to cover medically necessary prescription drugs, including those 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; and more.

AB533 (Bonta) Surprise Bills: Protects patients from “surprise” bills from out-of-network doctors when they did the right thing by going to an in-network hospital or imaging center or other facility. The bill would ensure that such a consumer only has to pay the in-network cost sharing.

AB1305 (Bonta) Limitations on Cost Sharing in Family Coverage: Ensures that an individual patient faces the ACA-set individual out-of-pocket maximum (now $6350), even if they are in a family plan (which has an overall family out-of-pocket max of $12,700). If it’s just one person in the family that got sick, they shouldn’t be penalized for being in a family plan rather than an individual one.

Health Access California is supporting and opposing other key bills, listed here on our website, along with fact sheets and sample letters.

COUNTY INDIGENT CARE PROGRAMS: Tomorrow, Tuesday morning, the Fresno County Board of Supervisors will vote on the future of their indigent care program, after more than a year of debate and discussion. Health Access will report on that, and developments in Sacramento and other counties about their health care safety-net, when we present on our recent report, “Reorienting the Safety-Net for the Remaining Uninsured: Findings from a Follow-Up Survey of County Indigent Health Programs After the Affordable Care Act.” at a California Endowment-sponsored webinar this Thursday, April 9th at 11am. You can register at this link.


Recent Budget Subcommittee Hearings on DMHC and DHCS

The Assembly and Senate budget subcommittees recently held hearings on the budgets for the Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS). You can read the agendas for the Senate Budget Subcommittee #3 on March 19 and in Asm. Budget Subcommittee #1 for more details about these proposals.

Department of Managed Health Care

DMHC’s budget was heard in Senate Budget Subcommittee #3 on March 19 and in Asm. Budget Subcommittee #1 a few days later on March 23. DMHC’s mission is to regulate, and provide quality-of-care and fiscal oversight for health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Health Access supported DMHC’s budget change proposals for additional staff and resources for the following work, and both committees left these items open (did not take a vote) in order to collect more information.

  • Federal Mental Health Parity: DMHC requested staff positions to address workload associated with conducting medical surveys of the 45 health plans that need to comply with the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA requires health plans that offer mental health benefits to do so in a manner comparable to medical and surgical (medical) benefits. Assessing whether health plans are in compliance with MHPAEA involves reviewing health plans’ processes and justifications for classifying benefits into classifications (inpatient, in-network; inpatient, out-of-network; outpatient, in-network; outpatient, out-of-network; and emergency care), determine parity for financial requirement (e.g., deductibles, copays, coinsurance); quantitative treatment limitations (e.g. number of visits, days of treatment) and non-quantitative treatment limitations.
  • Additional Enrollment in the Individual Market: DMHC helps California consumers resolve problems with their health plans and works to provide a stable and financially solvent managed care system. The ACA and California law requires health plans offering coverage in the individual market to accept every individual that applies for that coverage. Last year, DMHC estimated that 90 percent of all new enrollees in individual market plans would be under the jurisdiction of DMHC while the other ten percent would be under jurisdiction of the CA Department of Insurance (CDI). It turns out that DMHC has jurisdiction over approximately 98 percent of the enrollees in Covered California individual market plans. DMHC is requesting additional staff positions to address the increased workload resulting from the revised projected increase in enrollment in the individual market.
  • Large Group Claims Data (SB 1182, Leno, 2014): Last year, Health Access supported Senator Leno’s SB 1182, which requires health plans and insurers to provide de-identified claims data to a large group purchaser. The bill increases transparency by making information available to large group purchasers that helps them understand what is driving their premiums, better negotiate rates, and help efforts to improve the health of employees through disease management programs. DMHC is requesting staff positions to implement the bill.
  • Dental Plans Medical Loss Ratio (AB 1962, 2014): Last year, Health Access also supported AB 1962, which requires dental health plans to report their dental loss ratio to DMHC. Getting information about how much health plans spend on administration vs. actual care will help consumers understand the value of their dental plans. The data collected under AB 1962 will also help the Legislature to establish a dental medical loss ratio after 2018.

Department of Health Care Services (DHCS)

The Senate Budget Subcommittee #3 heard the DHCS budget on March 19. (Assembly Budget Subcommittee #1 heard DHCS’ budget on February 23, and you can read the Health Access blog post on that hearing here.) DHCS operates a number of programs that health care services to eligible individuals, namely Medi-Cal. Medi-Cal coordinates and directs the delivery of health care services to approximately 12 million individuals, including low-income families, seniors and persons with disabilities, children in families with low-incomes or in foster care, pregnant women, low-income people with specific diseases, and childless adults up to 138 percent of the federal poverty level.

  • Medi-Cal Estimates and Caseload: The Governor’s budget assumes total annual Medi–Cal caseload of 12.2 million for 2015–16. This is a 2 percent increase over the revised caseload estimate of 12 million for 2014–15. Health Access agreed with the Legislative Analyst Office‘s (LAO) that actual caseload information, not estimates, would help the Committee make better decisions. DHCS has begun posting monthly caseload data on its website. We believe the Administration’s estimates are too high because they don’t fully account for people leaving Medi-Cal for other coverage and IT difficulties in getting more accurate data. Health Access reiterated its support for using monthly caseload data, and the department will provided updated numbers in the Governor’s May Revise.Health Access also supported the committee staff’s recommendation to adopt placeholder trailer bill language to eliminate nonemergency emergency room copay in Medi-Cal. The copay has never been implemented because the state has not received approval from the federal Centers for Medicare and Medicaid. We believe the copay unnecessarily imposes additional costs on low-income people who need health care. Studies have shown that the copay does not affect ER use.
  • CalHEERS Oversight: CalHEERS is the IT system that supports the single, streamlined application process for Medi-Cal and Covered California. CalHEERS has had a number of problems, resulting in key populations not being able to access the coverage they need. For example, under the ACA, former foster youth qualify for Medi-Cal coverage until age 26 regardless of their income. This law has been in effect since January 1, 2014 but has not been programmed accurately into CalHEERS, resulting in enrollment delays, enrollment in the wrong affordability program, or denial of Medi-Cal for former foster youth. Consumer advocates continue to be concerned about the lack of transparency and stakeholder engagement in setting the policies and priorities for CalHEERS, contrary to the requirements of AB 1296 (Bonilla, 2011). Specifically, stakeholders have received limited updates regarding CalHEERS changes but have not had an opportunity to give input on those priorities. Health Access echoed the concerns raised by WCLP and other consumer advocates and urged the subcommittee to maintain oversight over this issue.

We have also joined our colleagues at the California LGBT Health and Human Services Network and Equality California to press for the inclusion of optional questions regarding sexual orientation and gender identity (SOGI) demographic data on the Medi-Cal/Covered California application. Because of the ACA’s prohibition on discrimination, as well as the emphasis on affordability, many LGBT individuals and families can get Medi-Cal or private health insurance for the first time. LGBT people face many health disparities, which are reflected in higher rates of breast cancer, tobacco use, drug and alcohol abuse, violence, and suicide, as well as worse mental health outcomes. These disparities are due at least in part to a long history of being discriminated against by medical providers and denied medically necessary care, as well as inability to access health insurance. Collecting data about SOGI is a critical part of addressing these health disparities and help us evaluate whether the investments we’ve made in outreach and enrollment in LGBT communities are working. At the hearing, DHCS publicly committed to working toward making this a reality. You can read the CA LGBT HHS Network’s letter on collecting SOGI data here.

  • Dental Services in Medi-Cal: The Committee heard testimony about a recent California State Auditor (CSA) audit of the Denti-Cal Program, which found that some counties may not have enough providers to meet the dental needs of children in the program. The utilization rate for Medi-Cal dental services by children is low relative to national averages and to the rates of other states. CSA stated a primary reason for low dental provider participation is California’s low reimbursement rates for these services. The federal CMS has directed California to improve access to dental care for children, and DHCS proposes to accomplish this by targeting the use of mobile dentistry vans in Alpine, Amador, and Calaveras counties and increasing outreach to families with children aged 0-3 who haven’t seen a dentist in the last year.

DHCS has also proposed to require local Child Health and Disability Prevention programs and providers to refer all Medi-Cal eligible children participating in the program to a dentist beginning at age one instead of at age three. Health Access supports this proposal because it makes California responsive to direction from CMS for the state to improve the rate at which young children receive dental services. This proposal was supported by consumer advocates and dental providers.

  • Medi-Cal Provider Rates and Access: The Governor’s Budget continues the AB 97 Medi-Cal payment reductions, which is estimated to save $550M. Consumer advocates, providers and their associations, and others were on-hand to express their concern that the existing Medi-Cal rates, payment reductions, and rate freezes have negatively impacted Medi-Cal enrollee’s ability to access Medi-Cal services. There was testimony that rates are too low to cover the cost of providing services to Medi-Cal patients. Health Access supported restoring the AB 97 rate cut to improve access to Medi-Cal.
  • Medi-Cal Annual Open Enrollment: DHCS is proposing trailer bill language that would lock some Medi-Cal beneficiaries (those under family and child aid codes) into their managed care plans for a full year and only allow them to change plans during a mandatory open enrollment period. Health Access opposes this proposal because it limits consumer choice and access–while health plans can continue to change their providers mid-year.
  • Elimination of COLA for County Eligibility Administration: The Governor’s proposed budget includes a budget trailer bill proposal to permanently eliminate the annual cost-of-living (COLA) adjustment for reimbursements to counties for administering Medi-Cal eligibility. The State is in the midst of crafting a new reimbursement methodology, but the new methodology is not yet in place. Until then, Health Access, along with the County Welfare Directors Association (CWDA), believes it’s premature to eliminate the COLA. The Legislature and Governor currently have the ability to suspend the COLA on an annual basis, which is what has been done the past several years. In the meantime, counties are getting supplemental funding from the state for the increased workload as a result of ACA implementation.

Happy 5th Birthday, Affordable Care Act—LA Celebrates, Highlights Work Still Left to Do

This blog entry was written by Nancy Gomez, Health Access’ Southern California Program Director

On Monday March 23rd Health Access gathered with key partners, health care consumers, and elected officials in Los Angeles to celebrate the 5th Anniversary of the Affordable Care Act. Approximately 70 people enjoyed the celebration and press conference (and, let’s not forget, cake).photo2_LASpeakers included:

  • Joan Pirkle Smith, Health Access California Board Chair (and event MC) kicked off the celebration with an overview of Health Access’ just published ACA 5th Anniversary Report. The report, a collaboration involving many coalition and community partners, describes implementation, impacts, and needed improvements going forward.
  • LA Supervisor Mark Ridley Thomas spoke of the accomplishments of the ACA nationally, statewide, and countywide, including the continued efforts of My Health LA, the LA County program that has already enrolled over 75,000 people including the undocumented. He also addressed the need to address access issues and disparities that still remain and that disproportionately impact immigrant and under-served communities.
  • Celinda Milagros Vazquez, Planned Parenthood LA’s VP of Public Affairs, described the many benefits of the ACA for women, in particular reproductive rights, and highlighted the work of community Promotoras (community health workers).
  • Spike Dolomite Ward, a health care consumer, shared her personal story of going uninsured simply because she was self employed, only to find herself at a loss hearing the news from her doctor: Stage 4 breast cancer. The ACA “saved my life,” she shared, because she was able to enroll in the PCIP (Pre-Existing Condition Insurance Program) which ultimately provided her with the life-saving treatment she needed before Covered California first opened for enrollment in October of 2013.
  • Dr. Rishi Manchanda of the National Physicians Alliance spoke about being able to provide care to previously uninsured patients and highlighted the new consumer protections, no-cost preventive care, and other positive changes of the ACA. He also underscored the need to expand Medi-Cal for the undocumented population.
  • Gustavo Herrera, California Director of the Young Invincibles, outlined the successes of the ACA for people 18 to 32, the affordability options, and current advocacy priorities for the Young Invincibles.
  • Astrid Campos, Campaign Manager for the Children’s Partnership, touched on the ACA’s many benefits and coverage options for children and the work that still needs to be done to ensure 100% coverage for ALL children in California.
  • Riana King, Health Care Consumer (Young Invincibles), shared her personal story of being diagnosed and treated for her Crohn’s disease and her deep appreciation to the ACA for allowing her to remain covered under her parent’s insurance plan, which made it possible for her to have the surgery she desperately needed and the lifelong treatment she will require.
  • California Immigrant Policy Center Executive Director Reshma Shamasunder, described the benefits of the ACA for communities of color and the work that still needs to be done in terms of SB4 (#Health4All) and and the need to provide care for the underserved and under-represented.

The event also included an awards ceremony recognizing the role of the state’s elected officials in the state’s success to date on the ACA. Each of the following state leaders were honored with “Health Care Champion Award” plaques:

  • Members of Congress:  Adam Schiff, Judy Chu, and Karen Bass
  • Senators:  Ricardo Lara, Ed Hernández, Holly Mitchell
  • Assemblymember:  Jimmy Gomez

Many of our friends and partners participated in the planning of the event including:

  • Planned Parenthood Los Angeles
  • Children’s Defense Fund, California Chapter
  • Children Now
  • California Partnership
  • Children’s Partnership
  • California Immigrant Policy Center
  • Young Invincibles


Thank you again to all who joined our celebration and pledged to continue their advocacy and support around SB4 and securing coverage for all.

Please see photos of our event here:

Some of the press coverage included: