Affordable Care Act Implementation Fast-Tracked by Governor's Special Session in Legislature
By Anthony Wright
Monday started a special session of the California Legislature, called by Governor Jerry Brown last week, to pass laws to continue to implement the federal Affordable Care Act, and get California ready to take advantage of the benefits available starting in January 1, 2014.
In Governor Brown's release of his proposed 2013-14 budget earlier this month, California committed to the historic Medicaid expansion in the ACA, that would expand coverage to around one million Californians. In his State of the State speech last week, Governor Brown cited California's leadership in putting place the new options and consumer protections under the federal law, and called the special session to move forward. From the Governor's speech:
California was the first in the nation to pass laws to implement President Obama’s historic Affordable Care Act. Our health benefit exchange, called Covered California, will begin next year providing insurance to nearly one million Californians. Over the rest of this decade, California will steadily reduce the number of the uninsured. Today I am calling for a special session to deal with those issues that must be decided quickly if California is to get the Affordable Care Act started by next January.
California needs to move quickly on health reform implementation and Medicaid expansion, so we are ready to start enrolling Californians in coverage in October of this year - in less than nine short months.
On Thursday, the Governor issued the following Proclamation, for a special session to begin today, and is expected to continue for a few months, running concurrently with the Legislature's existing session and work. Bills in the special session will operate on a faster timeline, and once passed and signed, they will go into effect in 90 days after session, rather than waiting until January 2014 for their enactment, as would legislation in the normal session. In the Proclamation, the Governor proposes three areas for action:
WHEREAS, an extraordinary circumstance has arisen and now exists requiring that the Legislature of the State of California be convened in extraordinary session;
IN WITNESS WHEREOF, I have hereunto set my hand and caused the Great Seal of the State of California to be affixed this 24th day of January 2013. NOW, THEREFORE, I, EDMUND G. BROWN JR., Governor of the State of California, in accordance with Section 3(b) of Article IV of the Constitution of the State of California, hereby convene the Legislature of the State of California to meet in extraordinary session in Sacramento, California, on the 28th day of January, 2013, at a time to be determined, for the following purpose:
To consider and act upon legislation necessary to implement the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), in the following areas:
- a. California’s private health coverage market, and rules and regulations governing the individual and small group markets related to guaranteed issue of coverage, pre-existing condition exclusions, rating restrictions, and any other requirements necessary to conform state law to federal rules.
- b. California’s Medi-Cal program and changes that are necessary to implement federal law, including requirements for eligibility, enrollment, and retention.
- c. Options that allow low-cost health coverage to be provided to individuals who have income up to 200 percent of the federal poverty level within the California Health Benefit Exchange, to the extent allowed by federal law or regulations.
California has already put in place a number of laws to implement the Affordable Care Act, from key consumer protections in 2010, to the requirement that premiums dollars go to patient care in 2011 to the standards for essential benefits and the reforms of the small group insurance market in 2012. The Governor's list includes items that need to be done for California to by ready to enroll Californians in coverage in 2013 and have new coverage start in 2014. This list could change: it is the Legislature's prerogative to determine what they pass to send to the Governor, but the Governor's authority to sign or veto.
While components of the larger ACA reform effort, each of these pieces of expected legislation are major advances for access and affordability in their own right:
- The individual insurance market reforms will include the outright ban of insurers denying or discriminating against Californians for pre-existing conditions. State legislation is needed to give state regulators the authority to enforce the law, and for states to make decisions on crucial details, such as the number and size of the geographic regions that could get different rates. Other state statutory changes are needed to define cost-sharing parameters for health insurance products. Governor Brown vetoed a version of individual insurance reform legislation last year, seeking a specific change, and additional guidance has come from the federal government since.
- The reform of Medi-Cal is major, not just the expansion, but the streamlining and simplification that will make it cheaper to administer and easier for Californians to get on and stay on coverage. For example, eliminating the "asset test" in Medi-Cal not only reduces administrative burdens and barriers, but also a backward social policy that discouraged savings. In his State of the State, the Governor has suggested that part of the Medicaid reforms might be done not in special session, but on the slightly longer timeframe of the budget, which is scheduled to conclude in June. Decisions made in the budget and budget trailer bills go into effect immediately.
- The Governor has embraced the idea that the new Exchange, Covered California, offer a "bridge"plan that has the potential to provide continuity of care to folks who transition from Medi-Cal to Covered California as their incomes rise and fall, to provide greater choice and affordability for these lower-income Californians, and to provide more stability to county safety-net providers. Many health and consumer advocates support these goals and this concept, which does need federal approval and possibly state statute changes.
Community and consumer groups will be active in this legislative special session, alongside the regular legislative session and regular budget process, as well as monitoring and advocating their positions in the administrative and regulatory processes to implement the Affordable Care Act, at Covered California, the Department of Health Care Services, the Department of Insurance, the Department on Managed Health Care, and elsewhere. While our state has led in moving forward with health reform efforts, there's a lot of work to do, especially in a state with the size and complexity of California.
Outreach and Education Application Released
On Friday, Covered California, the state's Exchange that will serve as a marketplace for affordable health coverage in 2014 and beyond, released a request for proposals and is accepting applications for the Outreach and Education Grants program to help reach millions of low- and moderate-income Californians about their new options and benefits. The deadline for grant applications is March 4, 2013, but letters of intent are due sooner. Covered California has dedicated $43 million in funding over two years for "community organizations that can reach Californians of all walks of life where they live, work, play and shop."
Anthony Wright is Executive Director of Health Access California, a statewide health care consumer advocacy coalition of over 200 groups.