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Lawmakers in Sacramento are busy considering hundreds of bills as we enter the last week of the legislative session. Bills must pass both houses of the legislature before the end-of-the-week deadline to send them onto Governor Jerry Brown’s desk, or otherwise they are stalled for the rest of the calendar year.
Over twenty major bills necessary to implement the Affordable Care Act in California have been already been passsed and enacted over the last four years, including several major bills earlier this year in a special legislation, including legislation to reform the individual insurance market, ABx2 (Pan)/SBx2 (Hernandez), enacted May 9, 2013 in special session, and to expand and simplify Medi-Cal expansion, ABx 1 (Speaker Perez)/SBx 1(Hernandez/Steinberg), enacted June 27, 2013 in special session with elements in the budget and trailer bills.
COST SHARING CONSUMER PROTECTIONS: The biggest remaining element of the legislative implementation of the Affordable Care Act relates to cost sharing and is contained in SB639 (Hernandez), sponsored by Health Access. SB 639 (Hernandez) was passed yesterday afternoon with final amendments in Assembly Health Committee, and is now up for consideration on the Assembly Floor as early as today.
SB639(Hernandez) implements the provisions of the federal Affordable Care Act which limit out of pockets (deductibles, copays, co-insurance) to no more than $6,350 for an individual or $12,700 for a family. This will protect Californians from medical bankruptcy by limiting their costs for covered medical benefits.
Anyone with a very serious illness such as cancer, multiple sclerosis, HIV/AIDS or an organ transplant knows how fast the out of pocket costs can multiply unless they have good benefits. SB639 would prevent such patients from facing tens of thousands or even hundreds of thousands of dollars in coinsurance even though they had health insurance.
SB639 goes beyond the Affordable Care Act by:
· Limiting out of pocket costs in 2015 to no more than $6,350 for all essential health benefits.
· In 2015, not allowing an additional limit of $1,000 for pediatric dental: $1,000 plus $6,350 is more than $6,350—and $6,350 is already a lot of money for most of us.
· Protecting small employers and their employees from higher out of pocket limits in 2014, a year earlier than federal guidance requires.
Consistent with federal law, the bill also limits deductibles for small employer coverage, and defines the actuarial value tiers (platinum, gold, silver, bronze) for individual and small group law. As permitted under federal guidance, it also allows rates for the entire small employer market to be rebased quarterly though California law provides that small employers face rate increases no more than once a year.
SB639 is expected to come up for a final Assembly and Senate floor vote in the next two days.
OTHER BILLS: Several other health bills are pending, while others have already been passed by the Legislature and have been sent onto the Governor’s desk. An updated Health Access Bill List is available on our website, which will be revised at the end of session as well.
Bills still pending include AB1208 (Pan), which will be heard in Senate Health Committee today, which has been revised to allow data collection in health care on race, ethnicity, language, disability, sexual orientation, and gender identity. SB205(Corbett), to require 12-point font size on prescription drug labels, sponsored by the California Alliance for Retired Americans, is spending on the Assembly floor.
Bills that have passed the Legislature include SB353 (Lieu), to protects limited English proficient consumers from deceptive marketing by requiring plans to provide information in languages they market in; and SB161 (Hernandez), a set of key consumer protections in the small group market on “stop-loss” insurance.