The Plan for California Health Reform—2008 and Beyond

HEALTH INSURANCE INDUSTRY

Oversight & Market Reforms
• SB 1522 (Steinberg) Would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic.’’ Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans. Would weed out “junk’’ insurance by developing minimum benefit standards. Sponsor-Support
• AB 1554(Jones) Would regulate insurance rates. Amend
• AB 2589 (Solorio) Would require insurers who sell to public entities to disclose brokers fees. Support
• SB 1440 (Kuehl) Would require every insurer to spend at least 85 percent of premiums on patient care. Support, seek amendments
Rescissions
• AB 1150 (Lieu) Would outlaw the practice of paying bonuses to insurance company employees when they rescind policies, setting targets for rescinded policies and/or setting financial goals based on savings on health care claims. Support
• AB 1945 (DeLaTorre) Would require approval by Department of Managed Health Care or Department of Insurance for each individual rescission. Support
• AB 2549 (Hayashi) Would impose a six-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. Support
Benefits
• AB1962 (DeLaTorre) Would require all individual insurance policies to cover maternity services. Support
• SB 1553 (Lowenthal) Would address provider concerns and interactions with insurers about California’s existing mental health parity laws. Amend
Insurance Market Options
• AB 2 (Dymally) Would reform the Managed Risk Medical Insurance Program, which provides coverage for “un-insureables” who have “pre-existing conditions.’’ Efforts would make the high risk pool more affordable and available. Support
• Pending SB 1622 (Simitian) Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices. Support
Inadequate Insurance• AB 2292 (Garrick) Would allow Californians who have Health Savings Accounts, linked to high deductible health plans, to qualify for state personal income tax deduction. Oppose
• SB 972 (McClintock) Would create organizations of small businesses that could purchase unregulated and substandard health insurance products. Oppose
• SB 1669 (McClintock) Would allow insurance companies to exclude coverage of conditions for which an individual policyholder has received medical advice, a diagnosis, treatment, or prescription drugs at any point in the previous 10 years. Oppose
• SB 1603 (Calderon) Would give discount healthcare plans legitimacy in the state by allowing the Department of Managed Health Care to license and regulate such products. Oppose

Health Care Industry

Balance Billing
• AB 1203 (Salas) Would prevent emergency departments – which do not have a contract with a patient’s insurance company -- from directly billing the patient for services, requiring the hospital to seek reimbursement directly from insurers. Support
• SB 981 (Perata) Would prevent emergency physicians – who do not have a contract with a patient’s insurance company -- from directly billing the patient for services, requiring providers to seek reimbursement directly from insurers. Support

Provider Oversight
• AB 2741 (Torrico) Would require non-profit hospital sales to undergo health impact analyses to gauge the transaction’s effects on the affected community, health care services, and the community’s public interest. Support
• Pending AB 2842 (Ma) Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support
• AB 2821 (Feuer) Would limit drug company gifts to doctors to no more than $250 annually, require disclosure of non-gift payments made to doctors and require annual public disclosure of any gifts higher than $50. Support
• AB 2967 (Lieber) Would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. Support
• SB 1300 (Corbett) Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support
• SB 1351 (Corbett) Would require Attorney General oversight into transactions involving district hospitals. Support
Underserved Communities
• AB 1472 (Leno) Would establish the California Healthy Places Act, and require diverse state agencies and departments to work together assess and reduce health disparities in underserved communities. Support
• AB 2902 (Swanson) Would require the Office of Multicultural Health to encourage the use of community-based health care workers to help facilitate and coordinate better health outcomes in underserved communities. Support

For more information about legislation, please contact Hanh Kim Quach, policy coordinator, 916.497.0923 x 206 or hquach@health-access.org

Health Access California is a statewide health care consumer advocacy coalition of over 200 groups. This article has also been published on the Health Access Weblog.