Key Patient Protections Pass Legislature, Now On Governor’s Desk

With the California Legislature adjourning after midnight last Saturday, most of the action on priority bills for health consumers moves to the Governor’s desk. Most of the Heath Access-sponsored bills protecting consumers from unfair out-of-pocket costs are now one Governor’s signature away from enactment.

There were disappointments in the final days of this year’s legislative activity, including the lack of action on a range of revenue and tobacco control measures in the special session. Health Access’ consumer protection proposal AB 533 (Bonta), to halt surprise bills, failed on a vote of 38-10—just 3 votes short of passage. Overall, though, many important patient protections passed in a productive session advancing health reform.

Even if a bill makes it to the Governor’s desk and even with bipartisan support, all bets are off as to whether the Governor will sign that bill into law. In many instances, the case needs to be made again, but leading with values shared by Governor Brown—like fiscal prudence.

Please find below suggested talking points for emails and letters of support to the Governor. The Governor makes a point of reading all of the material accompanying each bill before making his decision, so please take time to craft meaningful organizational letters of support.

The Governor has until October 11 to sign or veto bills on his desk, but since we don’t know when he will tackle a given bill, it is best to get support letters and email messages (see steps below) in this week or next at the latest.

HEALTH ACCESS-SPONSORED PATIENT PROTECTION BILLS ON GOVERNOR’S DESK

Several measures against unfair out-of pocket costs were passed and sent to the Governor:

  • SB137(Hernandez) would require accurate, standardized, and updated provider directories by health plans. Recent surveys by the Department of Managed Health Care found that 25% of the directories of two major health plans were found to be inaccurate or out-of-date (see separate SB137 fact sheet).

Suggested Talking Points

  • Today’s inaccurate directories stand in the way of timely access to care, making treatable conditions more expensive to address.
  • Accurate directories make it easier for consumers to make thoughtful choices when they shop for or change coverage. This in turn helps Covered CA and other marketplaces evolve toward providing better value.
  • Inaccurate directories lead patients to inadvertently go out-of-network and face very high cost-sharing as a result.

 

  • AB339 (Gordon) would require insurers to cover medically necessary prescription drugs and limit cost-sharing on specialty drugs and other needed medications. The bill ensures coverage for drugs 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; places monthly cap on specialty drug cost sharing; and more (see separate AB339 fact sheet).

Suggested Talking Points

  • This fulfills the intent of the ACA to do away with discriminatory practices like excessive out-of-pocket costs for people with chronic conditions.
  • People are more likely to skip their medication if the cost sharing is too high. This interferes with treatment or makes conditions worse or more expensive to treat.

 

  • AB 248 (R. Hernández) Minimum Value Guarantee for Large Employer Coverage, to prohibit the sale of subminimum coverage, defined as coverage with less than 60% actuarial value, by insurers to large employers. Such plans put workers in a double bind: with unmanageable costs for uncovered care; but because they took up that coverage, often unwittingly, they are automatically ineligible for premium subsidies through Covered California (see separate AB 248 fact sheet).

Suggested Talking Points

  • Under current state law large employers can offer prevention-only or “junk” plans. Where they fall short in meeting the need for more comprehensive care, such plans perpetuate the pre-ACA problem of shifting costs to other parts of the health care system.
  • AB 248 levels the playing field for small businesses, which are required to provide comprehensive coverage.
  • Individuals who accept coverage offered by large employers may forfeit eligibility for premium subsidies—unknowingly.
  • AB1305 (Bonta) would ensure an individual patient does not face higher out-of-pocket costs just because they are in family plans, closing a potential loophole in the out-of-pocket maximum protections in the Affordable Care Act (see separate AB1305 fact sheet).

Suggested Talking Points

  • AB 1305 addresses a basic issue of fairness for people enrolled in a family plan, who should not have to pay more out-of-pocket than someone in an individual plan.
  • AB 1305 closes a loophole in the ACA, providing yet another example of California’s leadership in addressing state priorities for reform.

NOTEWORTHY ACTION & DISCUSSION ON OTHER PRIORITY BILLS

SB 4 (Lara) #HEALTH4ALL, a high priority bill for Health Access and many health and community groups, passed on a bipartisan vote in both the Assembly and Senate. In its amended format, SB4 provided mostly technical changes to make it easier for an estimated 170,000 undocumented children to be seamlessly enrolled in expanded Medi-Cal, as per the 2015-2016 budget enacted in June. Under these provisions, children enrolled in Restricted Scope Medi-Cal would be automatically enrolled in Full Scope, state-funded Medi-Cal. Children with special health care needs will also be properly evaluated and referred to the appropriate Medi-Cal managed care plan.

In the floor debate in the Assembly, Republican Assembly Member Rocky Chavez explained his support. He had originally opposed saying that the ACA had a long way to go before more people should be added to the Medi-Cal rolls. But he was moved to support the measure simply because it focuses on children—“why do we invest in education for all children, Chavez queried, “but not health care?” Another reason switched his vote to YES is the outreach of community groups, including the hundreds, if not thousands of calls he received asking for his vote.

Several other bills passed include a health care cost transparency measure SB546 (Leno), and also AB1231 (Wood) to ensure Medi-Cal coverage of nonmedical transportation for the purpose of getting rural patients timely access to care. The latter passed on a unanimous vote.

AB533 VOTE COUNT FALLS SHORT

Even the most careful consumers can get treated by an out-of-network provider at in-network facility only to receive a surprise bill for the difference between the provider’s charge and what the health plan pays—after the fact. That difference can run into hundreds, thousands, or even tens of thousands of dollars–an amount that could destabilize family finances or damage personal credit. AB 533 could have fixed this, and that it failed on just a few votes is doubly tragic for these patients.

In fact, a broad coalition of consumer groups, insurers, the California Labor Federation and the California Chamber of Commerce actively supported the measure, but the California Medical Association and related physician groups pulled out all the stops and prevailed in the end.

Based on a recent survey by Consumers Union which found 1 in 4 Californians received a surprise medical bill, it’s conceivable that in each Assembly district, thousands of patients will get “surprise bills.” All Californians can find out how their Assembly Member voted or if they declined to vote as many did. Those dealing with this problem first hand should also share their story for next year’s effort (click here).

TOBACCO CONTROL: The other major disappointment of the night was that there was no vote on pending tobacco control legislation—worthy proposals from a tobacco tax to regulating e-cigarettes to raising the age to purchase cigarettes to 21. Thankfully, all of those measures are in special session, so they do not have the same deadline as regular legislation–but the Legislature is not expected to return until January of 2016.

TAKE ACTION NOW

Where we end up at the close of the legislative session is with serious momentum to address a number of critical priorities for health care consumers.  Now let’s finish the job by submitting fresh letters of support. To urge Gov. Brown to sign each of these bills into law, follow these steps—separately for each bill you or your constituents wish to support:

  1. For each bill, visit this link: https://govnews.ca.gov/gov39mail/mail.php
  2. Enter name and email address.
  3. Under Choose Subject, select Legislation Issues/Concerns
  4. Do not check that you want a reply (unless you do).
  5. Position: select Pro
  6. Write your email: keep it brief and to the point. For example:

“Please sign SB 137 into law. Provider directories should be accurate so that patients can shop for the best plan and get care at the right time and place.

  1. Click on Send Email.

Thank you for helping to bring these bills all the way to the finish line.

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