California passes over a dozen important ACA 2.0/ other healthcare bills w/several more on the way!

Yesterday I noted that both houses of the California state legislature (Assembly and Senate) voted to expand Medi-Cal (the state's Medicaid program) to anywhere between 147,000 - 175,000 undocumented immigrants (young adults age 19 - 25 and seniors over 65), entirely funded using state dollars.

It turns out that this was only part of a marathon voting session yesterday over the past few weeks. Either the state Senate, Assembly or both have also voted to pass three a bunch of other healthcare-related bills (I've included simple descriptions of each):

BREAKING: California Assembly passes our #AB1246(@Limon) to align consumer protections for all Californians, including those in large group coverage. #Care4AllCA

— Health Access CA (@healthaccess) May 29, 2019

This bill would require most large group health plans to cover medically necessary prescription drugs.

BREAKING: #AB715 (@drarambulaAD31) to end the "senior penalty" in Medi-Cal passes off Assembly Floor 59-0! @Western_Center, @DisabilityCA, @justiceinaging #Care4AllCA

— Health Access CA (@healthaccess) May 29, 2019

Currently, seniors who earn more than about $15,000 a year and are enrolled in the Medi-Cal Aged and Disabled program must pay a monthly out-of-pocket fee for medical services, even though most adults who earn up to roughly $17,000 a year have free Medi-Cal. This bill would reduce the number of seniors who have to pay the fee by raising the maximum income level for the Medi-Cal Aged and Disabled program to $17,000.

Here's a better explanation of the problem:

California Health Advocates is one of over 60 organizations that have signed on in support of AB 715, which would raise the income level of the Aged and Disabled Medi-Cal program (A&D program) to 138% of the federal poverty level (FPL), creating a “bright line” of income eligibility. This would allow adults with full Medi-Cal, thanks to the higher Medi-Cal income limits implemented through the Affordable Care Act, to be able to keep their Medi-Cal when they become 65 and eligible for Medicare or are eligible younger than 65 due to a disability. Currently, the Medi-Cal A&D FPL income limits for people 65 and older or younger with a disability are only 123% of the federal poverty level, which means over 20,000 seniors are dropped from necessary coverage just because they are now also eligible for Medicare no longer have access to the higher income limit.

BREAKING: #AB414 (@RobBontaCA) to re-instate the individual mandate in CA passes Assembly floor 43-12 #Care4AllCA

— Health Access CA (@healthaccess) May 29, 2019

Both of these bills would establish an individual insurance mandate, including a state-level penalty for people who don’t carry health insurance. It would replace the federal fine that disappeared beginning this year. Covered California would determine the penalty and who would be exempt. Gov. Gavin Newsom wants to use revenue from the fine to fund subsidies in Covered California. He anticipates it will generate $500 million a year.

While the mandate bill passed through the Assembly easily, it looks like there was enough resistance in the Senate to put a hold on it for now, although I'm guessing it'll still go through later in the year:

It could become law if adopted through budget bill, and if not, there is Assembly bill that passed and will move for consideration in Senate (though could face opposition). Dems have major concerns that @GavinNewsom is not providing enough $$ for subsidies to go along w/mandate

— Angela Hart (@ahartreports) May 30, 2019

In all, California legislators have actually introduced a whopping 19 healthcare-related bills this session. Here's the other 15; nearly all have passed either the Assembly or Senate and are now in the hopper in the other legislative body. A few of them are still at the committee consideration stage:

AB 526: Introduced by Asm. Cottie Petrie-Norris (D-Laguna Beach); This bill would make it easier for eligible children and pregnant women in the federal Women, Infants, and Children program to enroll in Medi-Cal. UPDATE: This actually passed the state assembly last week!

SB 260: Introduced by Sen. Melissa Hurtado (D-Sanger); This bill would require health plans to send notices to people who lose their coverage for any reason, and to inform them about Medi-Cal and Covered California. Plans must also provide a list of people who lost coverage to Covered California so the exchange can contact those who lost coverage directly. Hurtado says the bill will reduce coverage gaps when people’s income or other life circumstances change. UPDATE: This actually passed the state Senate last week!

SB260 sounds a little bit like Maryland's just-signed "Easy Enrollment" law. In that case, anyone who isn't insured can check a box on their state tax forms and the state will either automatically enroll them in Medicaid or they'll contact the taxfiler and help them enroll in ACA exchange coverage if they qualify for financial assistance.

AB 1309: Asm. Rebecca Bauer-Kahan (D-Orinda); This bill would extend the application period for Covered California by two weeks. Starting in 2018, most federally administered exchanges created under the Affordable Care Act shifted to a shortened enrollment period ending Dec. 15. In California, consumers have until Jan.15. This bill extends the deadline to Jan. 31.

Hmmm...OK, this isn't a bad thing but it seems a little silly, given that California already passed a law last year locking in the Open Enrollment Period from Oct. 15 - Jan. 15th. Why on earth they didn't simply make the dates Nov 1st - Jan. 31st in the first place, I have no idea. UPDATE: This bill also passed the state Assembly a few days ago.

AB 1063: Introduced by Asm. Petrie-Norris (D-Laguna Beach); Federal waivers allow states to find new ways to improve health care in exchanges created under the Affordable Care Act. Last year, the Trump administration began allowing state exchanges to apply for waivers without explicit state legislative authority. Under the looser rules, health advocates are worried states will try to offer coverage that undermines the Affordable Care Act. Health Access and the Western Center on Law and Poverty are sponsoring the bill, which would prohibit Covered California from applying for a waiver without approval from the Legislature and the governor.

I didn't realize that state-based ACA exchanges could apply for CMS waivers on their own, actually, but I suppose this is a good thing as a precautionary measure. UPDATE: This bill passed the state Assembly a few days ago.

AB 174/SB 65: Introduced by Asm. Jim Wood (D-Santa Rosa) / Sen. Richard Pan (D-Sacramento); These bills both would require Covered California to provide more financial help to low-income residents buying health insurance. Assembly Bill 174 would establish a tax credit beginning in 2020 for individuals who currently earn between 400 and 600 percent of the federal poverty level, or more than $48,000 a year for an individual and more than $100,000 a year for a family of four. These families are not currently eligible for Affordable Care Act tax credits. The Senate bill would require Covered California to implement premium contribution limits, while also reducing copayments and deductibles for people with incomes between 200 and 400 percent of the federal poverty level.

This is the other Big One, which also goes hand in hand with the reinstatement of the individual mandate (see above). It turns out it actually already passed both the state Assembly and Senate last week, but it sounds like the Senate wants the subsidies beefed up further, which I support as well:

BREAKING: The CA Assembly voted 57-0 to pass #AB174 (@JimWoodAD2) to provide greater subsides to those who purchase coverage in @CoveredCA. CA would be the first state to take this step to help more middle-income families afford care #Care4AllCA

— Health Access CA (@healthaccess) May 23, 2019

...AB 683: Introduced by Asm. Wendy Carrillo (D-Los Angeles); Seniors in the Medi-Cal Aged & Disabled program are currently restricted to $2,000 in a bank account, or $3,000 for couples, because of something called the “assets test.” These types of restrictions were eliminated for most other Medi-Cal enrollees under the Affordable Care Act. Senior advocates say the rule requires seniors to deplete their assets in order to be eligible for health coverage, and that it disproportionately affects seniors of color. The bill would raise the limit to $10,000 for an individual, exclude certain items from the assets test, and eliminate the test for Medicare Savings Programs.

AB 1088: Introduced by Asm. Wood (D-Santa Rosa); This bill affects seniors who are enrolled in both Medicare and Medi-Cal. These seniors sometimes lose their Medi-Cal coverage when the state begins paying their Medicare Part B premiums, because those payments bump them above the Medi-Cal income eligibility threshold. Wood’s bill would make it so the Medicare payment is not counted as income. UPDATE: This passed the state Assembly yesterday as well.

AB 318: Introduced by Asm. Kansen Chu (D-San Jose); This bill aims to improve translations in the Medi-Cal program. It would require the Department of Health Care Services and Medi-Cal managed care plans to review translated materials for Medi-Cal beneficiaries for accuracy, cultural appropriateness and readability. UPDATE: This passed the state Assembly last week.

SB 464: Introduced by Sen. Holly Mitchell (D-Los Angeles); The state’s health department is currently required to maintain a maternal and child health program, and the Office of Health Equity must track ethnic and racial health statistics on infant and maternal mortality, among other issues. This bill would require hospitals, birth centers and clinics that provide perinatal care to implement an implicit bias program for all providers, in an effort to reduce racial disparities. The providers would have to complete training at the outset, and a refresher course every two years. The bill would also change the way deaths of pregnant women are recorded on certificates. UPDATE: This passed the state Senate last week.

AB 537: Introduced by Asm. Wood (D-Santa Rosa); This bill would require California’s Department of Health Care Services to create a rating system for Medi-Cal managed care plans. Advocates say the state should be holding plans accountable for improving quality and reducing health disparities.

AB 929: Introduced by Asm. Luz Rivas (D-Arleta); This bill would require the Covered California board to make information on health plans’ cost reduction efforts, quality improvements and disparity reductions public. The board would have to post the data on its website annually in a way that “demonstrates the compliance and performance of a health plan, but protects the personal information of an enrollee.” UPDATE: It looks like this bill passed the state Assembly in early May.

AB 731: Introduced by Asm. Ash Kalra (D-San Jose); Under current law, health plans offering individual or small group coverage must file information about total earned premiums and incurred claims with the California Department of Insurance or the Department of Managed Health Care at least 120 days before implementing a premium rate change. This bill would require plans offering large group coverage to do the same and would impose additional disclosure requirements. UPDATE: This passed the state Assembly last week.

SB 343: Introduced by Sen. Pan (D-Sacramento); This bill would remove an exclusion in state law that allows certain health systems, including Kaiser Permanente, to keep some insurance costs and hospital financial information private. Under the bill, Kaiser would be held to the same data disclosure requirements as its competitors. UPDATE: This bill passed the state Senate in early May.

AB 1611: Introduced by Asm. David Chiu (D-San Francisco); This bill would limit what hospitals can charge a patient, or the patient’s plan, for emergency care in cases where the hospital does not have a contract with the patient’s health plan. It’s an effort to stop what advocates call “surprise billing”, or hospitals landing patients with large and unexpected costs after providing care.

This is another really important bill--cracking down on "Surprise Billing" is a huge deal at both the state and federal level these days.

AB 824: Introduced by Asm. Wood (D-Santa Rosa); Wood says brand name drug manufacturers sometimes enter into contracts with generic drug manufacturers, whereby the generic company delays marketing their version of a drug in exchange for payment. Wood’s bill would outlaw the practice. UPDATE: Passed the state Assembly last week!