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.  

Two seats get big attention

by Brian Leubitz

The media thrives on big statements, but shades of gray are everywhere. And that is true for the Senate elections here in California. So, with that, here is a “big statement” quote from former FPPC chair (and SoS candidate) Dan Schnur:

“If Republicans can win both of those seats, it will be seen as their first step back toward political relevance in California,” said Dan Schnur, director of the Jesse M. Unruh Institute of Politics at USC. “But if Democrats get the supermajority back, it’s difficult to see California becoming a two-party state again any time in the near future.” (LA Times)

To be clear, these two races are very worthy of attention. They are getting very expensive, as both sides look to grab an advantage. And, in terms of the supermajority, this is where the ballgame will be decided. But, is the supermajority really that important? Are there a lot of supermajority measures that will get taken up next year? It seems unlikely, and with the budget only requiring a majority, taxes are the only instance where you would really need it.

And if the GOP can pull off a win in one or two of these districts, does that really mean they are on the road back? Yes a lot of money will be spent in those two districts, but there is little to draw casual voters to these elections. The Presidency isn’t up this year, and the governor’s race is a snoozer. Will a GOP win say anything about the future, or will it say more about the electorate of the past?

If the Republicans aren’t able to win at least one, it would certainly present a dark picture for the future. Their two candidates, Andy Vidak and Janet Nguyen, are fairly strong in favorable electoral conditions. If they can’t win now, when will they win? This is where I tend to agree with the drastic part of Schur’s quote. The GOP, and more importantly their financial backers, will have to look at massive change if they can’t win these two seats this November.

Measure to require donor disclosure for nonprofit political dies in Senate

by Brian Leubitz

Take a step into my TARDIS, way back to 2012, when a group of conservative nonprofit groups with connections to the Koch Brothers poured around $15 million into the efforts to defeat Prop 30 and pass Prop 32. Eventually, they settled for a record fine of over a million dollars, but hey, if you can get away with it, #AmIRight? What’s a million dollars between friends trying to monkey with democracy?

Well, a bill to fight just these sort of money laundering operations was working its way through the state Legislature. SB 27, introduced by Senator Correa would have required every ballot committee receiving more than $1 to disclose its top ten contributors.

I say was, because with the loss of the votes of Sens. Wright and Calderon and the current lack of Democratic supermajority, that measure seems to be on ice for a while. No Republicans would cross party lines and vote for public disclosure, so despite the passage in the Assembly, the measure goes nowhere. CORRECTION: A previous version of this post said a supermajority was required due to a requirement of constitutional amendments. However, SB 27 is not a constitutional amendment. Rather, the Political Reform Act of 1974 requires a 2/3 supermajority to make changes.

“Senate Republicans should be ashamed of themselves for voting to keep Californian’s in the dark about who is funding political campaigns,” said SoS candidate Derek Cressman.  “How anyone favoring fair and transparent elections could have no preference between the party of dark money and the party that voted unanimously for sunshine today is a mystery to me.”

by Steve Smith, California Labor Federation

It’s easy to be pessimistic about the future these days. Tea Party extremists are threatening to push our federal government into default. Federal immigration reform is on the back burner until the shutdown and debt ceiling messes are sorted out. In a host of states, anti-worker governors are hell-bent on gutting workers’ rights while giving more power to corporate special interests.

But in California, a decidedly different story is playing out. The end of the legislative session here brought huge gains to workers and their families that boost our state’s economy and bolster the middle class.

With the federal minimum wage stuck at $7.25, Gov. Brown signed AB 10, taking California’s minimum wage to $10 per hour by January of 2016, a 25 percent wage increase for low-wage workers in the state. While immigration reform is stalled in DC, Gov. Brown signed a slew of bills to protect immigrants and ensure greater inclusion. We’ve tackled the underground economy. Promoted good jobs. Axed a boondoggle of a corporate tax break that wasted taxpayer dollars.

This all comes on the heels of the passage of Prop. 30 in 2012 (which funded our schools and stabilized our budget) and the election of Democratic super-majorities in both the State Assembly and State Senate, ensuring Tea Party extremists couldn’t hold California hostage like they’re doing with the shutdown and debt ceiling debacle in DC.

In short, California is accomplishing what few in Washington DC can even imagine these days: Progress for working people.

California Labor Federation Executive Secretary-Treasurer Art Pulaski:

Labor led the way this year in bringing real equality and progress to working people in California. We reformed tax breaks that cost jobs, we won rights for domestic workers and car wash workers, we brought greater equality to hard-working immigrants, and we began the essential work of rebuilding the state’s middle class. With these new laws, there’s no question that California is the national leader in supporting workers and their families.

Among the notable legislative victories this year were the following bills Gov. Brown signed into law:

• AB 10 (Alejo/Steinberg): Increased the minimum wage to $10 per hour by January of 2016.

• AB 60 (Alejo): Expanded drivers licenses to all Californians, with key protections for immigrant drivers.

• AB 93 (Assembly Budget Committee): Reformed the wasteful Enterprise Zone corporate tax breaks to reward employers who create good jobs.

• AB 241 (Ammiano): Granted daily and weekly overtime protection to domestic workers who have been excluded from most labor laws.

• AB 263 (Hernandez)/AB 524 (Mullin)/SB 666 (Steinberg): Enacted the strongest protections for immigrant workers in the country to stop retaliation when workers speak out about unfair wages or working conditions.

• AB 537 (Bonta): Improved process for public sector bargaining to resolve disputes more effectively.

• AB 1387 (Hernandez): Protected car wash workers by preserving the car wash registry and increasing the bond to crack down on the underground economy.

• SB 7 (Steinberg): Raised wages for construction workers by incentivizing compliance with prevailing wage laws.

• SB 168 (Monning): Helped protect workers working for farm labor contractors by providing successor liability to ensure wages are paid.

• SB 400 (Jackson): Helped domestic violence survivors keep their jobs and promotes a safer workplace by asking employers to work with survivors to identify and minimize the risk of workplace violence.

• SB 770 (Jackson): Expanded paid family leave to include time providing care for parents-in-law, siblings, grandparents and grandchildren.

Learn more about California Labor’s legislative victories in 2013

If America needs a path forward, it ought to be looking to California. Big things are happening here. And we’re just getting started.

Progressives push legislature to use supermajority for big change

by Brian Leubitz

When the Legislature hit the magical 2/3 mark after the November 2012 election, a lot of progressives started dreaming big. Prop 30 just passed, and a statement had been made for a progressive vision of California. A majority of Californians had just voted to raise their taxes. Whether thanks to the strong field campaign around Prop 32 or through changing demographics of a presidential election, the Democrats gained big on the Legislative front.

But muddying these waters was a lot of mixed messaging. Gov. Brown had at least signaled that he thought Prop 30 was the only tax revenue measure that we should pass for a while, and some of the Democratic legislators had more or less said the same thing.

On the other side, the dreams were building for those who focused less on the immediate political future and more on the long term progressive vision. Progressive leaders were looking at Prop 13 reform, oil severance taxes, minimum wage increases and more. A lot of powder has been kept dry over the past few years with the constant budget fight, and with that superminority concern out of the way, some looked to really mount the pressure. And to be clear, they have mounted a lot of pressure. I’ve seen enough of these discussions between progressive leaders and legislators to know that the pressure on them is real.

“The supermajority is something that you have to use it or lose it,” said Rick Jacobs, head of the 750,000-member Courage Campaign, which has been at the liberal vanguard of several grassroots and online campaigns. “It is time to be bold. What is anybody afraid of?” (SF Chronicle)

To some extent, this is about two competing theories of politics. One says that you have a limited supply of “capital.” Under this model, you can only expect to do so much progress on the legislative front. Gov. Brown is pushing for a gradual and slow movement that prioritizes consensus and getting buy in from as many as possible. On the other hand, progressives tend to favor an idea of politics that promotes efficiency. You get into it what you put in kind of thing. Voters will respect action, even if they don’t get every component right away.

But for now, Speaker Perez and Sen. Steinberg seem to be of the same mind as the Governor. They’re taking it slow for the time being. Steinberg has said that he doesn’t plan on [touching Prop 13 this year, and Speaker Perez thinks this is just the beginning of a larger fight.

Even though Democrats could override Brown’s veto with their two-thirds majority, “a lot of Democrats from more conservative areas don’t want to vote to raise taxes because they know it would kill them in their districts,” said Steve Maviglio, a spokesman for Assembly Speaker John Pérez.

Plus, say Democratic leaders, it is still relatively early in the legislative calendar. Budget negotiations are just beginning.

“C’mon, it’s only the second inning. There’s a lot of time left in the session,” said Maviglio. “We’re moving forward on a lot of bills that are friendly to labor and progressives.

“I would tell some of the people who are saying these things to just relax,” Maviglio said.(SF Chronicle)

Now, perhaps that last sentence could be more eloquently phrased, but Mr. Maviglio speaks of building a long term progressive supermajority in the Legislature. It’s a laudable goal by any Democratic perspective, but getting everybody on the same page isn’t necessarily the easiest task, even within the same party.

Supreme Court considers whether the referendum is “likely to qualify”

by Brian Leubitz

UPDATE: Well, I’ve had a bit of time to digest the hearing, and I’m still as unsure what they will do as I was at 9AM.  There are essentially a few different options:

1) Don’t intervene until there is more indication of whether the referendum will qualify.  While there is great speculation in the political world whether it will qualify, the hearing itself didn’t seem to really focus all that much time on this issue.  “Likely to qualify” has some history as a term in the Court’s jurisprudence, but much of it essentially comes down to a fluidity based on context.  The Court could use this in many ways to justify one outcome or another.

2) “Intervene” now, but leave the map in place.  Justice Liu brought up this suggestion. As there is a dearth of time to create a new map, and the map drawn by the commission represents the best attempt at trying to draw a map that meets all the goals of the legal requirements.  This, as you would expect, would make the Republican proponents none too happy.

3) Intervene and have voters vote on the old map.  This idea came up a couple of times during the hearing, and it just seems insane to me.  The old maps had to be changed because we had population shifts. Thus, using the old maps would mean that people would have unequal representation in the Senate.  Now, there is some legal precedence for this when there is a really good reason, but I just think this “solution” raises a lot more questions than it answers.

4) Intervene and have voters vote on a new map.  Where do we start on this one. Well, you could have a special master draw the map. The Republicans wouldn’t be guaranteed that they would like that one any more than they like the Commission’s map. And, as a bonus, you get a process that essentially has no transparency because the judges and the special master just wouldn’t have time to take any public comment.  

The related system that came up was “nested Assembly districts”, meaning just smush two Assembly districts and bam, you have a Senate district map. But that system would result in some pretty nasty Voting Rights Act questions, and then you are back at square one with having to design a new map.

I think that John Myers was right when he tweeted that the Justices were inclined to intervene.  However, I just don’t know that they have any good options to replace the Commission’s map.  We should have a ruling by the end of the month at the latest.

See also a good wrap up from John Myers on the hearing.

Back to the original post  

As I write this, the CA Supreme Court is considering whether to produce their own maps, use the old maps, or stick with the Commission’s maps.

You can watch the hearing live here.  

John Myers has been tweeting the hearing, and while he thinks that the Supremes are leaning toward intervening, I think it is still something of an open question.  I have learned to never underestimate James Brosnahan.

Follow my twitter feed for more.

There are a few points that are important here:

1) Is the referendum “likely to qualify”?

That is a difficult question of fact, and not at all clear.  The proponents did not turn in the usual cushion that would make it really likely to qualify.  The number of signatures puts qualification at risk.

2) What alternative map would you use?

Using the old maps, one of the proponents suggestions, presents the question of equal representation. The other main alternative would be to hire one special master, and basically have that person draw the maps. Is that really what the voters wanted when they voted for the commission?

Senate Minority Leader Bob Dutton left leadership post recently, Bob Huff expected to replace him

by Brian Leubitz

Republicans don’t often break out of their molds, but, wow, they outdid themselves this time.  They found a SoCal Senator from the outer burbs named Bob to replace a SoCal senator from the outer burbs named Bob. Really quite amazing.  On the right you see Bob Huff, the incoming Bob, and Bob Dutton, the outgoing Bob is on the left.

Today is their first day back in recess, so the official word should come down soon. Now is also the time where you can also expect to hear something from them about how great term limits are, or something like that.  That would be particularly awesome because Dutton is now seeking to return to the Assembly, where he has two terms left.  

From a perspective of actual differences? Well, don’t hold your breath.  At this point, they are simply in desparation mode to try to retain any relevancy.  Under the new maps (which they are attempting to put to a referendum), there is a very real chance of a 2/3 Democratic majority. If the Senate Republicans do find themselves below the 1/3 mark, they’ll find themselves watching as the Assembly Republicans are the only Republican source of power in the Capitol.  

Now, I’m not sure that means much, what with the Republicans pretty much saying no to all revenue measures and the budget now requiring only a majority vote.  But, nonetheless, meet the new Bob!  

Measure would put maps on the ballot in June, leave 2012 districts to the Courts

by Brian Leubitz

As I’ve mentioned here in the past, the Senate maps aren’t so much biased, as no longer crazy incumbent protection rackets.  And with that risk, the Republicans face the very real risk of losing their 1/3 superminority and thus becoming pretty much irrelevant.  I’ve outlined many of the complexities of the situations if the measure does qualify, but let’s go with complicated.

But that is a big if at this point. Scott Lay in his wonderful Nooner daily email laid out the situation for qualification:

As expected, the referendum of the state senate plan met the raw count requirement. With 51 counties reporting, 697,392 signatures were counted. Now, counties have until January 10 to conduct and report a random sample for validity. If fewer than 95% of the 504,760 required signatures are projected to be valid, the referendum fails. If the projection exceeds 110% of the required signatures, it qualifies. In between, it proceeds to a full count.

This will be a nail-biter, with the validity of the 209,163 signatures from Los Angeles likely being make-or-break. In contrast, paycheck protection/deception is on track to qualify with 920,569 signatures and a 70% validity rate (before Los Angeles has reported). Carrying forward the trend, it will have 648,000 signatures and won’t need a full count. To avoid failure, redistricting petitions need 68.8% validity in the random sample. With 79.6% validity, a full count will be avoided.  If a full count occurs, actual validity of 72.4% would be needed.

Typical validity rates are between 70 and 77 percent, so while the low-end 68.8 will likely be met, there is no guarantee.  A full count could mean that we don’t know whether this will be on the ballot until March. At which point, it would be nearly impossible to draw up some new set of maps.  At this point, it seems tough to imagine a situation where we aren’t voting on the commission’s maps.  If the June referendum winds up somehow tossing the maps out…well, more fun will surely ensue.