Important health reform bills that moved forward would put in place key consumer protections in the individual insurance market including the prohibition on insurers denying or discriminating based on pre-existing conditions; set an “essential benefits” package so patients can have confidence in their coverage; implement the expansion of Medi-Cal; and provide notices to inform Californians of their coverage options in the new Health Exchange when people make job or life changes.
A much-discussed option that stalled today included the proposal to esablish a Basic Health Plan for Californians between 133%-200% of the poverty level. (Without a BHP, those Californians will continue to get coverage through the Exchange). Other bills that stalled included an implementation of caps on out-of-pocket costs, a requirement on insurers for greater disclosure of enrollment and claims data, and a study on the effectiveness of wellness incentives in health policies.
All bills passing out of Committee today have the opportunity to progress toward passage by the August 31st end of session deadline, while those that were held will not. Surviving bills must pass floor votes in the second house in the next two weeks in order to make it to the Governor’s desk. If passed, the Governor will then have the month of September to sign or veto the bills.
Assembly Bills Moving Forward
Assembly bills that have cleared the Appropriations hurdle will face scrutiny on the Senate floor in the next two weeks. They are:
AB43 (Monning) MEDI-CAL ELIGIBILITY: Changes Medi-Cal rules to reflect eligibility changes to reflect the Affordable Care Act, effective January 1, 2014; reducing barriers to enrollment such as the assets test while expanding coverage to 2 million Californians.
AB792 (Bonilla) AUTOMATIC ENROLLMENT: Ensures that Californians can easily sign up for coverage during key life changes. Requires California consumers are provided information about the Exchange upon filing for divorce, separation, unemployment, adoption, or other life circumstances.
AB1453 (Monning) ESSENTIAL HEALTH BENEFITS: Protects consumers from underinsurance and junk insurance by requiring health plans to cover a set of minimum essential health benefits equivalent to the Kaiser Small Group HMO.
AB1461 (Monning) REFORMING THE INDIVIDUAL MARKET: Prevents insurers from denying or discriminating for pre-existing conditions, and otherwise conform and phase-in new insurance market rules for individuals who purchase insurance on their own. Limits different premiums based on age to 3:1.
AB1526 (Monning) HIGH RISK POOL: Improves the Major Risk Medical Insurance Program (MRMIP) by eliminiating annual and lifetime caps so that individuals with pre-existing conditions will be protected if they are in need of extremely costly care, and brings the program in line with PCIP, the federally funded high risk pool.
AB2392 (Perez) MEDI-CAL INTERPRETER SERVICES: Directs the Department of Health Care Services to seek federal dollars to provide interpreter services for Medi-Cal patients.
Senate Bills Moving Forward
SB677 (Hernandez) MEDI-CAL ELIGIBILITY: Changes Medi-Cal rules to reflect eligibility changes to reflect the Affordable Care Act, effective January 1, 2014; reducing barriers to enrollment such as the assets test while expanding coverage to 2 million Californians.
SB951 (Hernandez) ESSENTIAL HEALTH BENEFITS: Protects consumers from underinsurance and junk insurance by requiring health plans to cover a set of minimum essential health benefits equivalent to the Kaiser Small Group HMO.
SB961 (Hernandez) REFORMING THE INDIVIDUAL MARKET: Prevents insurers from denying or discriminating for pre-existing conditions, and otherwise conform and phase-in new insurance market rules for individuals who purchase insurance on their own. Limits different premiums based on age to 3:1.
SB970 (DeLeon) HORIZONTAL INTEGRATION: Helps individuals applying for public programs apply through an integrated no wrong door approach, whether applicants are interested in social services or health programs.
SB1410 (Hernandez) INDEPENDENT MEDICAL REVIEW: Improves the process by which consumers appeal denial of care dicusions by making the process more robust and transparent. Also requires collection of race, ethnicity, and language data to help determine whether health equity issues need to be addressed.
SB1431 (DeLeon) SELF-INSURANCE IN THE SMALL GROUP MARKET: Ensures consumer protections for workers and a affordable small group market for small businesses by limiting a loophole for small employers to “self-insure” in order to evade requirements of the small group market.
Bills that Previously Passed Appropriations and Up for Floor Votes
The above bills will join a handful of legislation that has already moved on for consideration on the floor of the second house. They are:
AB441 (Monning) ACTIVE TRANSPORTATION, HEALTHY COMMUNITIES: Requires that transportation planning include health criteria in order to foster healthier communities.
AB1083 (Monning) REFORMING THE SMALL GROUP MARKET: Conform to federal law and phase-in new insurance market rules for small businesses, particularly so that small employers don’t get additional premium spikes based on the health of their workforce.
AB1580 (Bonilla) STREAMLINING ELIGIBILITY AND ENROLLMENT: A follow-up to AB1296 (Bonilla) which was signed into law last year to streamline eligibility and enrollment processes.
AB1761 (Perez) DECEPTIVE MARKETING: Prohibits any individual or entity from falsely representing themselves as the California Health Benefits Exchange.
Health Reform Bills Not Moving Forward
Unfortunately, some important bills for California health care consumers will not be moving forward this year.
AB1800 (Ma) OUT OF POCKET COSTS: Sponsored by Health Access and the MS Society, this bill limits out of pocket costs for consumers and simplify the separate deductibles insurers can charge so consumers have a clearer understanding of what their costs will be.
AB1636 (Monning) WELLNESS INCENTIVES: Creates a process to review and evaluate the effectiveness of wellness incentive programs.
AB2350 (Monning) DISCLOSURE: Would require health plans to make available key information, to the Department of Managed Health Care and the Department of Insurance, about the products they sell in the insurance market, including enrollment and disenrollment data, and claims data.
SB703 (Hernandez) BASIC HEALTH PLAN: Establishes a basic health plan, for Californians between 133-200% of the poverty level, pursuant to the federal Patient Protection and Affordable Care Act. Would improve affordability for these individuals. Shifts 35%-40% of adults with subsidies from the Exchange to Basic Health Plan.
For more information about these bills, contact the author of this report, Linda Leu, at firstname.lastname@example.org.