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Last year, Governor Schwarzenegger signed into law bills that moved California to the forefront in enacting the national health reform law. Legislation enacted last year created the California Health Benefits Exchange, an entity whose goal is to craft a set of health insurance plans available at affordable prices by 2014.
Whether California continues to forge ahead on this front now rests with Governor Jerry Brown, who must sign or veto several health reform bills by October 9th. Brown faces decisions on several other laws that would align state and federal law and help consumers find their way to the health exchange and other new coverage options.
One bill, SB 51, by Senator Elaine Alquist would replicate federal guidelines on “medical loss ratio,” or the proportion of premium dollars that insurers will be expected to spend on patient care. Like the federal law, this measure would require that health insurers in the large group market spend 85 percent of premium dollars on services to patients. The law would require insurers to issue rebates to employers and other health insurance customers if they fall short.
Another pending bill, AB 922 (Monning), would revamp the Office of the Patient Advocate (OPA) to be a central point of contact for Californians with questions or complaints about health coverage and services. The bill moves the OPA from the Department of Managed Health Care to the Health and Human Services but provides ongoing funding from the Department of Insurance and the Department of Managed Health Care.
Another measure is meant to ensure that patients who qualify for new programs under health reform have “no wrong door” to signing up. For instance, thousands of additional patients will qualify for Medi-Cal when the poverty ceiling to qualify for the program is raised and opened to new classes of patients, such as single men. The bill, AB 1296 by Assemblywoman Susan Bonilla, is meant to help an estimated 4.7 million additional people expected to qualify for coverage when health reform takes full effect in 2014. The bill seeks to fend off scenarios in which people are confused and confounded about what they qualify for – and how to sign up.
Lastly, the Governor is considering a bill, AB 185 by Assemblyman Roger Hernandez, which would mandate health insurers to cover maternity care. Brown’s signature on the bill would phase in the mandate to offer maternity care only about 18 months ahead of the health reform law, which defines maternity care as an “essential benefit” for insurers to offer by 2014.