California Legislative Appropriations Committees just voted to pass key legislation, including SB4 #Health4All (Lara) to expand coverage regardless of immigration status and several patient protection bills limiting out-of-pocket costs. Though some bills were amended in today’s suspense hearings (details below), all will advance to floor votes next week. To advance this year, all bills must pass by the June 5th deadline.
Health Access CA-Sponsored Bills on Out-of-Pocket Costs Heading to Floor Votes
- SB137 Accurate Provider Directories (Hernández):This bill, co-sponsored with CPEHN and Consumers Union, sets standards for health plan provider directories and creates more oversight on accuracy so people know whether their doctor is in network when they shop coverage, change coverage, or try to use their coverage. SB137 passed Senate Appropriations Committee 6-0 and now goes to the full Senate.
- AB 533 Surprise Bills (Bonta): This bill, which passed Assembly Appropriations on a bipartisan vote, 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 also ensure that the consumer only has to pay in-network cost sharing.
- AB1305 Limitations on Cost Sharing in Family Coverage (Bonta): This bill, which passed the Appropriations Committee on a bipartisan vote, conforms to federal rules and regulations to ensure that an individual patient faces the ACA-set individual out-of-pocket maximum (now $6600), even if they are in a family plan (which has an overall family out-of-pocket max of $13,200). If it’s just one person in the family that gets sick, they shouldn’t be penalized for being in a family plan rather than an individual plan.
- AB 339 Prescription Drug Cost Sharing (Gordon): This bill requires insurers to cover medically necessary prescription drugs, including those for which there are 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. Key provisions include: Imposing a monthly cap on co-pays. These protections are similar to what Covered California recently adopted, but would apply to all California plans. The bill heads to the full Assembly.
Other Top Priority Legislation
- SB 4 #Health4All (Lara): With today’s amendments, SB4 would expand Medi-Cal eligibility regardless of immigration status to kids (0-19) as an entitlement; expand coverage for adults regardless of immigration status as budget allocations will allow (not an entitlement, which meand that enrollment would be capped when funding runs out). By way of a Section 1332 waiver (formal request to the federal government), SB4 would also allow people to purchase coverage through Covered CA using their own money.
- SB 33 Medi-Cal Estate Recovery (Hernández). This bill would limit estate recovery in Medi-Cal to the federally required minimum of long-term care services and eliminate recovery from the estate of a surviving spouse of a deceased Medi-Cal beneficiary. It passed Senate Appropriations Committee 5-0 and now goes to the full Senate floor.
For details on other bills, check our updated Bill Matrix.
What happens next…
Consumer and health advocates are gearing up for floor votes next week.
- If you are part of an organization, now is the time to update letters of support addressed to bill sponsors.
- If you are a consumer or you work with consumers who will be helped by any of the bills listed above, please circulate our call for stories. These stories will be useful for bill hearings in the opposite House and for the home stretch when the bills (hopefully) land on the Governor’s desk.
THANK YOU FOR DOING ALL YOU CAN TO PROTECT CALIFORNIA’S HEALTH CARE CONSUMERS FROM UNFAIR OUT OF POCKET COSTS.