Winning and Losing Health Care Bills in Sacramento at the Legislative Deadline—A Busy Week

SB 1593 (Alquist) passed, which stipulates that children currently covered by county health initiatives would be the first in line to receive Medi-Cal and Healthy Families coverage once those programs are expanded to cover children up to 300% of poverty ($52,800 for a family of three). Currently, only citizen children up to 250% of poverty are covered by the state. Many counties now pick up the population between 250% and 300% of poverty. Two bills – SB 32 (Steinberg) and AB 1 (Laird/Dymally) would expand state coverage.

SB 1459 (Yee) passed, but with conditions for significant amendments, given the grilling by committee members, and their statements of concern and opposition about elements of the bill. The bill would consolidate both the Healthy Families and Medi-Cal programs under one name “Cal-Health’’ and sought to expand coverage for some children and some adults. Some advocates supported the stated intent to streamline enrollment and expand coverage, but many also raised concerns and/or opposition, with regard to the structure and specific provisions. These included issues about the inclusion of covering all children, the proposal's relationship with current child expansion strategies, the interaction with already-passed streamlining efforts, the privitization of county eligibility workers, the diversion of funding from public providers to private plans, and the viability of public hospitals.

MANAGED CARE: Another bill that got significant discussion was SB 1332 (Negrete-McLeod), which sets up a a pilot that would mandate that seniors, and people with disabilities in San Bernardino and Riverside counties be required to enroll in Medi-Cal managed care plans. While it passed despite opposition from consumer, low-income, and labor advocates, the chair, Senator Kuehl, admonished the author to address their concerns, about the potential impact of the mandatory enrollment on these vulnerable populations, and the overall safety-net.

BENEFITS: A number of bills dealt with mandated benefits for consumers in insurance plans. Two bills that would guarantee additional benefits passed. One bill that took away benefits failed.

* SB 1198 (Kuehl) would require health plans to offer coverage for durable medical equipment, such as wheelchairs, bath seats and crutches, at the same levels applied to other benefits. Passed on a bipartisan vote.

* SB 1634 (Steinberg) would require the coverage orthodontic services for cleft palate. Passed on a bipartisan vote.

* SB 1669 (McClintock) would have allowed insurance companies to exclude coverage of conditions for which an individual policyholder has received medical advice, a diagnosis, treatment, of prescription drugs at any point in the previous 10 years. Failed with Republicans voting in support and Democrats voting in opposition.

OVERSIGHT: SB 1525 (Kuehl) would require the state to review how health plans decide what services are “medically necessary’’ and should be paid for, and which are not. Passed on a bipartisan vote.

ASSEMBLY HEALTH COMMITTEE PASSES BILLS TO HELP CONSUMERS

With deadlines fast approaching, the Assembly Health Committee on Tuesday tore through and passed nearly three dozen bills, including many that would improve the benefits provided in bare bones, high deductible health plans.

The bills considered Tuesday with the broadest reach were:

* AB 1887 (Beall), which would provide coverage for all mental illness – not just the most serious.

* AB 1962 (De La Torre), which would require all plans cover maternity services.

For these and other bills that would require certain benefits as part of coverage, the biggest impact would be felt in the individual market, where premiums are expensive, but benefits are skimpy. The trend is especially acute for maternity coverage, where the California Health Benefits Review Board reports that the number of Californians without maternity benefits has tripled from 192,000 in 2004 to 600,800 today.

For Assemblyman Hector De La Torre, the issue was fairness, and of "spreading the risk." He countered the opposition of some of the health plans, who stated that the bill would eliminate lower priced premium products from the market. “It’s a false choice’’ that is being given to consumers, he said. “It’s not really a choice when all of the options are equally bad. Women are forced to choose between a product they can afford, without the coverage they need. Or a product they can’t afford, with maternity coverage.’’

Other bills of interest to consumers that passed committee Tuesday included:

* AB 3027 (De Leon) requiring health plans to translate materials into threshold languages.

* AB 2400 (Price) requiring public notice before closing a hospital.

* AB 2146 (Feuer) which bans billing when a hospital or physician has made a preventable, “never mistake,’’ such as operating on the wrong arm, or wrong person.

* AB 2220 (Jones) would require providers and health plans to go to binding "baseball" arbitration when they can’t agree on payment for services provided to a consumer, rather than having providers bill consumers directly.

Bills, votes, and analyses are available at the website of the California legislature.

A broader list of pending bills of interest to health and consumer advocates is updated and available at the Health Access website.

Hanh Kim Quach is the Health Care Policy Coordinator for Health Access California. Before joining the organization, she worked as a journalist for nearly 9 years covering issues in California. 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.