The Senate and Assembly adjourned Thursday, one day ahead of the June 5th deadline to pass all bills out of the first legislative chamber. The good news is that most key bills of interest to health care consumers have passed out of the house of origin, while one bill, opposed by public health groups, was defeated. Bills moving forward deal with limits and protections against unfair out-of-pocket costs; efforts at improving Medi-Cal; and most notably a significant expansion of access to coverage for all regardless of immigration status.

These bills now head to the second half of the legislative process. For details on each bill, see our weekly bill matrix:

http://www.health-access.org/i…

Below the fold, full reports on:

* SB 4 To Take Historic Steps to #Health4All & Cover the Remaining Uninsured

* Patient Protection Bills To Limit Out-of-Pocket Costs

* Additional legislation on transparency, Medi-Cal, tobacco control, and more

SB4, THE FRAMEWORK FOR #HEALTH4ALL REGARDLESS OF IMMIGRATION STATUS

The most-watched health bill was SB4, the first bill to pass a state legislative body that would explicitly expand coverage regardless of immigration status. The California Senate passed SB4 on a historic and bipartisan vote, 28-11, with all Democratic senators and 2 Republican senators voting in support. This bill, which continues California’s path to #Health4All, moves on to the Assembly Health Committee for consideration.

With last week’s amendments in the Senate Appropriations Committee, SB 4 would:

* Expand Medi-Cal eligibility to all children regardless of immigration status, as an entitlement;

* Expand coverage for undocumented adults as budget allocations will allow (to be decided each year in the budget, and that enrollment will be capped if funding runs out).

* By way of a Section 1332 waiver (a formal request to the federal government), SB 4 would allow all Californians to purchase coverage through Covered California using their own money.

Senator Ricardo Lara, author of SB 4, called the vote “historic” and one that Senators will remember long after their term is over. “We are talking about our friends, our families, our neighbors. Illness doesn’t care about our immigration status,” said Lara, describing the bill as still “realistic, balanced, and fiscally prudent.”

Several Senators rose to speak during the floor debate. From the opposing side, GOP Senators Jeff Stone, Janet Nguyen, and Bob Huff raised concerns about cost, arguing that expanding Medi-Cal was a “false promise” until the program addresses access issues. Several Democratic Senators responded to that argument, including Senator Richard Pan who stated, “We certainly need to make fixes to Medi-Cal, but certainly being on Medi-Cal is better than being uninsured.” Senator Isadore Hall derided “excuses,” Senator Ben Hueso wanted focus on the issue at hand: “We have a solution on the table, and we should move it forward.” Senator Hernandez rebutted concerns about cost: “The most inefficient way to provide health care is through the emergency room-we all pay for it.”

The most noteworthy speech was by GOP Senator Andy Vidak announcing his support for the bill while also raising the need to address Medi-Cal access issues and federal immigration reform. He and another Central Valley Republican, Senator Anthony Cannella, were the two GOP Senators to vote for the bill. Senator Nguyen abstained, with the rest of the caucus voting no.

This issue is currently pending in Budget Conference Committee as a $40 million item in the Senate’s budget proposal. The next week or two will make a big difference in whether enrollment under SB4 would start in the budget year 2015-16.

BILLS LIMITING OUT-OF-POCKET COSTS

Four Health Access-sponsored consumer protection bills to prevent unfair out-of-pocket costs passed out of their “house of origin” this week and are heading to the second half and second legislative chamber in the weeks ahead. The remaining sponsored bill, AB 248 (Hernandez) on large employer junk insurance is further along in the process, having passed out of the Assembly several weeks ago.

* Requiring Accurate Provider Directories: SB 137 (Hernandez) would set standards for provider directories and establish more oversight on accuracy so people know whether their doctor and hospital are in network when they shop for coverage, change coverage, or try to use their coverage. SB 137 passed out of the Senate with bipartisan support. The final vote was 33-0.

* Preventing Surprise Bills: AB 533 (Bonta), which would protect patients from “surprise” bills from out-of-network doctors when they did the right thing by going to an in-network hospital, imaging center, or other facility, passed out of the Assembly with a vote of 74-1.

* Limiting Prescription Drug Cost Sharing: AB 339 (Gordon), which would prevent discrimination against consumers with health conditions by setting standards for cost sharing on prescription drugs passed out of the Assembly with a vote of 48-29.

* Capping Individual Out-of-Pocket Costs: AB 1305 (Bonta) on limitations on cost sharing in family coverage passed out of the Assembly with a vote of 78-0. This bill ensures that the ACA individual out-of-pocket maximum (now $6,600) will apply to individual patients-even if they are in a family plan (which has an overall family out-of-pocket max of $13,200).

* Prohibit Subminimum Coverage: AB 248 (Hernandez), which would prohibit sale of subminimum coverage by insurers to large employers passed out of the Assembly several weeks ago with a vote of 51-27 and will next be heard in Senate Health.

TRANSPARENCY

SB546 (Leno) would advance transparency in our health system by extending rate review to large group health coverage. This bill, which requires justification of above-average rate increases, passed out of the Senate with a vote of 23-16.

Other transparency bills faltered earlier this year, including SB 26 (Hernandez), which sought to create a health care cost and quality database, was held in Senate Appropriations Committee amid questions on how to finance it. Earlier in the process, AB 463 by Assemblyman Chiu to facilitate more disclosure on prescription drug costs was stalled in Assembly Health Committee. These efforts will likely be revisited in future years.

MEDI-CAL

Several bills designed to improve the Medi-Cal program, which now covers almost 12 million Californians, advanced out of their house of origin.

* SB 33 (Hernandez), which would limit estate recovery in Medi-Cal to the federally required minimum of long-term care services and eliminate recovery from the estate of a surviving spouse of a deceased beneficiary, passed out of the Senate with a vote of 33-0.

* AB 1231 (Wood), which would facilitate practical access to Medi-Cal specialty care through coverage of nonmedical transportation, also passed out with a vote of 76-0.

* AB 635 (Atkins), which would require the Department of Health Care Services to seek federal funding to establish a program to provide and reimburse for certified medical interpretation services to Medi-Cal beneficiaries with limited English proficiency, passed out of the Senate with a vote of 72-2.

* AB 366 (Bonta), which would require the Department of Health Care Services (DHCS) to report to the Legislature on Medi-Cal access passed out of the Assembly with a vote of 77-0.  Originally introduced as a measure to restore Medi-Cal provider reimbursement rates and bring them up to Medicare levels in future years, this bill came out of the Appropriations Committee’s suspense hearing significantly scaled back in scope. A companion measure SB 243 (Hernandez) was held in Appropriations during the suspense hearing and is not moving forward.

TOBACCO CONTROL

A handful of bills aimed at the negative health impacts of tobacco use passed, including SB 151 (Hernandez) to raise the smoking age from 18 to 21. SB 140 (Leno), which would revise the definition of tobacco products to include e-cigarettes, thus subjecting such products to the same regulations as other tobacco products, passed out of the Senate with a vote of 25-12.  Public health groups, including the Heart Association, Lung Association, and Health Access supported that measure and opposed the related bill SB 24 (Hill), which did not classify e-cigarettes as tobacco. Research suggests that e-cigarettes have much the same negative effect as cigarettes. SB 24 (Hill) failed passage.  

OTHER KEY CONSUMER BILLS

A full matrix of the latest on all active bills supported by Health Access and other health and consumer advocates is available online (here). That list includes ACA implementation legislation like SB 43 (Hernandez), which would extend the sunset date on essential health benefits standards from 2016 to 2018 and incorporate recent changes in federal guidance regarding habilitative care (services that help you keep, learn, or improve skills and functioning for daily living); AB 1117 (Garcia) would help bring more resources to Medi-Cal to improve immunization rates for 2-year-olds and AB 1299 (Ridley-Thomas) seeks to improve the delivery of mental health services for foster youth.

WHAT’S NEXT?

Now that these bills have passed the critical house of origin deadline, they will next be heard in the “other house,” meaning if the bill was introduced in the Assembly, it will be heard in the Senate, and if the bill was introduced in the Senate, it will be heard in the Assembly. Committee hearings will resume on June 8th. Policy committees have until July 17th to meet and report bills out of committee.

This blog entry is cross-posted at http://blog.health-access.org. It was written by Sawait Hezchias-Seyoum, Health Care Policy Advocate, Health Access. Stay tuned for tools and talking points to bring these bills to the finish line.  

The annual state budget process, which began in January, comes into focus later this week when the Governor releases the May Revision of his proposed 2015-16 budget. Health and community advocates are urging the Governor and the Legislature to include funding for critical health programs in upcoming budget negotiations. These investments continue the Affordable Care Act’s momentum by removing barriers to coverage, ensuring those covered in Medi-Cal get access to care along with important benefits, and extending coverage to the remaining uninsured.

The deadline for the Legislature to pass and the Governor to sign a budget is June 15. The Governor’s May Revision sets the stage for a short month of negotiations, shaped by information about how much of a surplus is available given the state revenues that came in during April tax time, and constitutional formulas that limit the use of these funds.

Recent Budget Subcommittee Hearings: Since introducing the budget in January, the legislature’s budget subcommittees have reviewed the Governor’s proposed budget along with budget requests from advocates. In recent days, the Senate and Assembly Budget Subcommittees on Health and Human Services completed their reviews of the Governor’s proposed budget, along with a range of urgent and needed health investments that were not included in the Governor’s proposed budget, from expanding coverage without regard to immigration status to limiting estate recovery in Medi-Cal to restoring Medi-Cal benefits. The subcommittees left most of these items open for further discussions pending the May Revision. Many consumer and community organizations including Health Access California were on hand to strongly support these critical investments.

Immigrant Health Care. Although the Affordable Care Act made health coverage possible for millions of Californians, it excludes undocumented immigrants currently living and working in any state. If and when the President’s executive order on immigration is upheld in court, those newly eligible for deferred action will have access to Medi-Cal. Advocates are proposing to expand that access to all Californians income eligible for Medi-Cal, without regard for immigration status, as proposed in SB 4 (Lara). The cost would be a small fraction of last year’s proposal, amounting to only 2 more cents for every dollar spent on Medi-Cal, but would make a world of difference for not just immigrant families, but for our health system and society.

Estate Recovery. Advocates are also seeking that California limit Medi-Cal estate recovery to costs associated with long term care services and supports, consistent with minimum federal requirements. Last year, the Governor vetoed a bill to limit Medi-Cal estate recovery, arguing the policy change should be considered in the budget instead. Health Access will continue to vigorously advocate for this policy change so that older low-income Californians don’t have to make a trade-off between seeking health care coverage and keeping their family home.

Restore Medi-Cal Benefits Eliminated in the 2009-10 Budget. Major cuts were made during the budget crisis that have yet to be restored, including Medi-Cal rates and benefits, and consumer advocates including Health Access request undoing those cuts. In this part week, the budget subcommittees heard a proposal to restore non-federally mandated yet critical Medi-Cal benefits that were eliminated for budgetary, not policy reasons, in response to the state fiscal crisis. They include, among other things: acupuncture, audiology, chiropractic, podiatry, speech therapy, and full restoration of adult dental coverage. Partial restoration of adult dental was done in the 2013-14 budget, which gives Medi-Cal beneficiaries access to preventative care, restorations, and full dentures. However, important services such as gum treatment and partial dentures or implants are still not covered in Medi-Cal. According to a recent study published in Health Affairs, California emergency departments experienced a spike in visits for dental issues after comprehensive dental benefits for adults were cut from Medi-Cal. The study further found that the lack of adult dental benefits shifts dental care needs to costly emergency departments where dental issues are not adequately addressed.

Medi-Cal Provider Rates. Many providers and consumer groups have sought to rescind the 10 percent Medi-Cal provider rate cut, which will encourage more providers to participate in Medi-Cal and help increase access for Medi-Cal beneficiaries. In fact, California’s Medi-Cal provider reimbursement rates are among the lowest in the nation, making access to doctors, specialists, and beneficiaries harder for some of the 12 million Californians with Medi-Cal coverage.

What’s Next: The Governor is expected to release his May Revision of the budget later this week. The budget subcommittees will then hold hearings to review the May Revision the following week (May 18-22), and the Budget Conference Committee will convene at the end of the month to hash out differences between actions taken by the two houses. A final budget must be passed by June 15th. Stay tuned for updates!

Latest round of HIV infections stirs new round of debate

by Brian Leubitz

California is world famous for its big budget Hollywood blockbusters. However, every day, the state churns out volumes of adult content. Current law requires very frequent HIV testing, but the logistics of those tests and the lag in detection mean that HIV isn’t always detected on time.  Of course, there is a way to make the business safer by using condoms, and many production studios require safe sex in their movies.

However, there is a lot of money in the business, and many studios who are a little more lax, or even outright opposed, in their condom usage. The County of Los Angeles passed Measure B last year, and that measure was upheld by a judge this year http://www.businessweek.com/ar… However, many studios simply moved their productions out of the traditional hub of such filmmaking in LA County’s San Fernando Valley and into neighboring counties.

Assemblyman Isadore Hall (D-Compton) tried in a couple different ways to get similar legislation at the state level. But ultimately, that legislation was blocked, allegedly by lobbyists for the adult film industry and Asm. Mike Gatto(D-Hollywood).

But in the last few days, a series of four adult performers have been found to be positive for HIV, likely caught through their work. The LA-based AIDS Healthcare Foundation is none too pleased. And in a press conference yesterday, some of those performers spoke about their experiences.

Last week, Cameron Bay, one of the adult film actors who recently contracted HIV, called for more porn producers to encourage the use of safe sex on set.

The actress says she was naive to trust industry STD tests and said other performers told her not to ask for condoms.

‘I learned that there’s always someone younger and sexier, willing to do something you’re not,’ Bay told the Huffington Post. ‘I think we need more choices because of that. Condoms should be a choice.'(Daily Mail UK)

The legislation is dead for this year, but it is sure to come back next year. And the AIDS Healthcare Foundation and their allies are vowing to bring more public pressure to bear next year. See the flip for the TV news story.

In the aftermath of 9/11, we saw thousands of workers develop devastating respiratory conditions and other illnesses as a result of exposure to toxic dust that filled the air in the days and weeks after the twin towers fell. To this day, these peoples’ plight continues to add misery to the ongoing tragedy of 9/11. What makes it even worse is that these people were assured the air was safe.   As we all know now, it wasn’t.

Today, sadly, history may be repeating itself in the Gulf of Mexico.

(Thank you to Ligia Ercius-Dipaola, who posted this video on the NRDC Action Fund Facebook Page)

Amazingly, despite reports like this one, BP “continues to pretend that – just like an oil spill of this magnitude could never happen – there also could not possibly be a worker health concern.”  While the potential health hazards posed by chemical dispersants and oil itself are debatable, it is clear that significant risks existed.  

Already, we’ve seen evidence of the impact that spilled oil can have on human health. For starters, an increasing number of workers and residents in Gulf Coast areas have reported “suffering from nausea, vomiting, headaches and difficulty breathing.”  Considering that oil contains “petroleum hydrocarbons, which are toxic and irritating to the skin and airways”, as well as volatile chemicals “which can cause acute health effects such as headaches, dizziness and nausea” it’s no surprise that these symptoms are appearing.

(Thank you to Gary Chattem, who posted this on the NRDC Action Fund Facebook Wall)

So now, with the “60 exposure-related complaints filed with the Louisiana Department of Health and Hospitals”, not to mention the “overwhelming evidence that many of the compounds found in crude oil are dangerous,” shouldn’t BP be protecting the people who are cleaning up this mess? If they aren’t doing so, why aren’t they?

The bottom line is this: people along the Gulf Coast deserve to know the facts regarding the dangers they are facing and how to protect themselves.  It’s bad enough that their economic livelihoods are in danger of destruction in part due to BP’s greed and recklessness.  But if their lungs and other organs are damaged by oil and dispersant particles in the air, more than their economic livelihoods could be damaged.

None of us should ever forget that this disaster was brought on, at least in part, by BP cutting corners to save a few (million) bucks, and by the government’s failure to prevent the company from doing so.  As a result, the unthinkable has happened.  We must learn from those grave mistakes, not repeat them.  That means, in the long term, ridding ourselves of our dangerous, destructive addition to oil.  But what must happen now – right now – is for BP to stop cutting corners with the health of the people cleaning up the Gulf.

At the minimum, BP must switch its philosophy from “hope for the best” to “do whatever it takes, whatever the cost, to make sure people are safe.”  If BP won’t “make it right,” as the company’s ads like to say, then the government should force BP to do so.  In the words of one Venice, LA mother: “I’ve got the two most beautiful children in the world. If something were to happen to them, how could I look in those baby blues and say, Mommy didn’t know?”  It’s a great question.  What’s the answer, BP?

(Thanks for the update. – promoted by Brian Leubitz)

The California State Plan on Aging estimates the population of seniors, over 85 years of age, will increase 172% over the next 20 years.  The most recent draft of the plan finds that “California’s older adult population will increase by 90 percent as members of the Baby Boomer cohort reach 60.” The Plan outlines the major areas of concern for seniors in the next four years.

EDIT By BRIAN: See the flip for more on the Plan on Aging.

The first goal of this plan is to make it easier for older Californians and their caregivers to access local information about services and programs available in their communities. One step to achieving this goal is currently underway. CalCareNetwork is being developed to provide a single searchable web site of information about home, community based and institutional long-term services.

To “enable older Californians, adults with disabilities and their caregivers to be active and supported in their homes and communities” is another stated goal of the state plan. Transportation issues are a major barrier to independence in many communities. Of note in the report is the acknowledgement that transportation planners have not worked with members of human services agencies to integrate the needs of seniors and those with disabilities.  California now has representatives from the Department of Transportation on the California Olmstead Advisory Committee to address transportation concerns from both the individual need and infrastructure perspectives. The Department of Motor Vehicles is developing a Three-Tiered Driver Assessment program. The goal is to keep drivers safely on the road for as long as possible, however this assessment could lead to more adults relying on alternative transportation.

One of the most dramatic changes to the health of seniors has been in the last century is the shift in the causes of death from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses. Californians may live many years with diseases that need to be managed to maintain health. Californians have increased their use of preventive health screenings however significant racial health disparities persist in the treatment of chronic health concerns.  Alzheimer’s disease and other forms of dementia continue to be a substantial concern for individuals and their families. The third goal of the state plan is to promote the health of seniors through increased participation in health  initiatives and expanding  the availability of programs for family caregivers.  Additionally the promotion of early intervention and treatment for mental health issues is a stated goal.

The final goal is to protect the rights of older Californians through the Long-Term Care Ombudsman Program and Health Insurance Advocacy and Counseling Program (HICAP).  Updates to these programs and tools to improve communication and recognize fraud are part of the state plan.

The State Plan on Aging is clear in its anticipated funding from the state, noting: “The Department considers increases in State funding unlikely even though the population of older adults and adults with disabilities will continue to increase.” Interestingly over three pages of the State Plan draft is dedicated to the “opportunities for volunteerism and civic engagement.” This is due to the fact that many services are provided within the Aging Network through volunteers. The California Department of Aging (CDA) notes it is difficult to recruit and retain volunteers. The CDA will work to encourage increased volunteerism among older adults for their peers and those with disabilities.

It is difficult to know how anyone program will be affected when the state budget is finalized. The concerns highlighted by this report necessitate planning for the increased needs of a rapidly growing population of seniors. Current fiscal concerns are leading to reduction in services as the leading edge of the baby boomers enters the period of greatest need to age well within their communities.

While the recruitment of volunteers is beneficial for these social programs it will not be a sufficient substitute for the dollars needed for transportation, care, and health concerns of the 14.6 million seniors expected to populate California in the coming decades.