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.  

(A great wrap-up of where we stand on federal health care reform and how the California delegation is doing. – promoted by Brian Leubitz)

Edited and updated from the Health Access Blog

Yesterday, Speaker Nancy Pelosi kicked off her August recess by meeting with health care providers and patients at San Francisco General Hospital, to promote President Obama’s health reform effort.

With the passage of H.R.3200 out of Energy and Commerce on Friday, and the other relevant committees earlier in July, she could rightly report historic progress. Such a health reform proposal has now moved farther than any previous attempt in the modern era, and it set the stage for a House vote in September after the August recess.

But health care reform hangs in the balance, with opponents of the President detemined to “rattle” Congressman by disrupting town hall meetings and otherwise create an anti-reform political environment. As has been stated on Calitics before, those who support health reform need to be active NOW AND THROUGH AUGUST, CALLING, WRITING, FAXING, and VISITING our California Congressional Representatives, with a positive message about reform and its various components, from a public health insurance option to minimum benefits standards to affordability subsidies to the financing that allows for the needed upfront investments.

Californians have a particularly important say in health reform in the House of Representatives, from the Speaker to key Committee Chairmen, to Caucus leaders, to the bulk of our 53-member delegation. Health reform supporters can call your member of Congress in support of health reform at 877-264-HCAN, or click here to help pass reform.

Below the fold, we’ll detail more about the bill, the process, and where California’s Congressional representatives have come down on health reform to date:

THE BILL: The House proposal, America’s Affordable Choices Act, H.R.3200, would dramatically secure and expand health coverage:

* making it more likely than people get and keep their on-the-job health benefits;

* improving and expanding public health coverage programs like Medicaid;

* providing significant subsidies for low- and moderate-income families to be able to afford health coverage; and

* placing new rules and oversight over insurers to protect consumers, from prohibiting denial for pre-existing conditions, to limiting out-of-pocket costs; to ensuring a minimum benefit package; to providing a public health insurance option for consumers to choose.

Intertwined in the overall package is a range of efforts to contain rising health care costs, from prevention and public health initiatives to better use of information technology and bulk purchasing.

Especially as this bill gets negotiated with what might come out of the Senate, there will be specific issues and advocacy around affordability, financing, employer responsibility, inclusivity, benefits, and the public health insurance option. But moving the bill is crucial to attain those goals, and the House bill, H.R.3200, is a comprehensive vehicle that is supported by dozens of leading consumer, labor, community, patient, and provider organizations, including Health Access California.

THE AUGUST RECESS AND AFTERWARDS: The August recess, as both Senators and Representatives spend more time in their states and districts, is seen by both supporters and opponents of health reform as a crucial time to sway Congressmembers on the high-profile issue.

In addition to a House vote after the recess, the Senate Finance Committee is planning to unveil and consider its’ version of health reform after the break by September 15th. Under this new timeline, a product from that committee would be joined with the Senate Health Committee passed a few weeks ago, and be considered on the Senate floor soon afterwards.

THE ACTION IN THE HOUSE: The Energy and Commerce Committee passed H.R. 3200 by a vote of 31-28. The vote was supported by all but five Democrats, and included the support of the six California Democrats on the panel: Chairman Henry Waxman, as well as Anna Eshoo, Doris Matsui, Jane Harman, Lois Capps, and Jerry McNerney. All Republicans opposed the measure, including the two California Republicans: George Radanovich and Mary Bono Mack.



This committee was the last of three committees to consider and pass out the historic legislation.

* In the House Education and Labor Committee, all the California Democrats voted for H.R.3200, including Chairman George Miller, as well as Lynn Woolsey, Susan Davis, and Judy Chu. The California Republicans voted against it, including Howard “Buck” McKeon, Tom McClintock, and Duncan Hunter.



* In the House Ways and Means Committee, chaired by Rep Charlie Rangel of New York, all the California Democrats voted for H.R. 3200, including Health Subcommittee Chairman Pete Stark, as well as Xavier Becerra, Mike Thompson, and Linda Sanchez. California Republicans voted against it, including Wally Herger and Devin Nunes.



Health advocates are urging members to THANK the members that voted for the health reform bill.

CALIFORNIANS IN CHARGE: California consumers are uniquely suited to have their voice heard in this debate. In the House of Representatives, California is well represented in this debate, from Speaker Nancy Pelosi, to key members of leadership like Representative Xavier Becerra, on down.

Each of the three committees of jurisdiction for health reform has a senior Californian in a top leadership position: Rep. Henry Waxman chairs the Energy & Commerce Committee; Rep. George Miller chairs the Education & Labor Committee, Representative Pete Stark is the second senior member of the House Ways & Means Committee, and the chairman of the health subcommittee. Given this leadership and authorship, H.R.3200 can be seen as “made in California.”

Californians were also integrally involved in the back-and-forth that led to the final agreement allowing passage from the final committee in the House.

California also has the largest contingent of “Blue Dogs” Democrats, who are self-described as more conservative, and who have been advocating concerns and changes to the health care legislation. However, of the seven California Blue Dogs, five have generally been supportive of health reform. By the beginning of the year, California Representatives Joe Baca, Mike Thompson, Jane Harman, Loretta Sanchez, and Adam Schiff signed on in support of Health Care for America Now! principles, and have been supportive of health reform in general and of the public health insurance option in specific. These five members declined to sign a “Blue Dog” letter that opposed health reform without specific changes.

The two other California “Blue Dogs” are Representatives Jim Costa and Dennis Cardoza, both of the Central Valley , and both signed onto that letter urging changes to the health reform. While neither was on a relevant committee, the signing of the letter gave support to the group that did negotiate for a delay in the house floor vote and that got amendments to the bill, including on the public health insurance option and reducing affordability subsidies. Ultimately, a compromise was reached where some (but not all) of the “Blue Dogs” on the Ways and Means Committee agreed to support the bill.

That compromise was a concern to progressive members, including many Californians. A letter signed by 57 members (14 from California!) of the Progressive Caucus and the Tri-Caucus circulated in the last week gave strong support to health reform but warned “we will not support a weakened public option.” In addition to the leadership of Progressive Caucus Chair Lynn Woolsey, Black Caucus Chair Barbara Lee, and Asian Pacific American Caucus Mike Honda, other California Representatives who signed the letter included Lucille Roybal-Allard, Laura Richardson, Maxine Waters, Judy Chu, Diane Watson, Jackie Speier, Bob Filner, Linda Sanchez, Grace Napolitano, Sam Farr as well as Pete Stark.



Further negotiations ensued between Chairman Waxman, Blue Dogs, and Progressives who were concerned with the Blue Dog compromise, leading to additional “unity amendments” to the bill that sought to bridge the differences, most notably to find savings to maintain the affordability subsidies for low- and moderate-income families.

ACTIONS: Health and consumer advocates, including Health Access California and Health Care for America Now!, are urging Californians to CALL, WRITE, AND VISIT their Congressional representatives this week and through August in support of health reform. Opponents are mobilizing to chip away at the support for health reform, and we need to be clear about the urgency, the need, and the popularity of reform.

Call Congress at 877-264-HCAN, or click here write to help pass reform.

* In particular, Californians should THANK the members of the various committees that voted for H.R.3200, including: Henry Waxman, George Miller, Pete Stark, Xavier Becerra, Anna Eshoo, Doris Matsui, Jane Harman, Lois Capps, Jerry McNerney. Lynn Woolsey, Susan Davis, Judy Chu, Mike Thompson, and Linda Sanchez.



* Californians should THANK the Progressive members that are advocating strongly for a robust public health insurance option and for affordability subsidies for low- and moderate-income Californians, including: Lynn Woolsey, Barbara Lee, Mike Honda, Lucille Roybal-Allard, Laura Richardson, Maxine Waters, Judy Chu, Diane Watson, Jackie Speier, Bob Filner, Linda Sanchez, Grace Napolitano, Sam Farr and Pete Stark.

* Californians should THANK the “Blue Dogs” that have distanced themselves from that caucus to be supportive of health reform, of the Health Care for America Now! principles, and of the public health insurance option, including Joe Baca, Mike Thompson, Jane Harman, Loretta Sanchez, and Adam Schiff.



* Finally, and most importantly, Californians should URGE California Representatives Jim Costa (D-Fresno/Bakersfield) and Dennis Cardoza (D-Merced/Modesto) to come out in support of health reform and H.R.3200. The Blue Dogs got key amendments that should address their concerns, and nowhere in the state or nation is in more need of health reform than the Central Valley of California.

* While you are at it, call California Senators Barbara Boxer and Diane Feinstein in support of health reform as well.

Call your member of Congress at 877-264-HCAN, or click to help pass reform.