BILL ANALYSIS
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THIRD READING
Bill No: AB 98
Author: De La Torre (D), et al
Amended: 9/4/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-4, 7/8/09
AYES: Alquist, Cedillo, DeSaulnier, Leno, Negrete McLeod,
Pavley, Wolk
NOES: Strickland, Aanestad, Cox, Maldonado
SENATE APPROPRIATIONS COMMITTEE : 8-5, 8/27/09
AYES: Kehoe, Corbett, Hancock, Leno, Oropeza, Price, Wolk,
Yee
NOES: Cox, Denham, Runner, Walters, Wyland
ASSEMBLY FLOOR : 50-27, 6/2/09 - See last page for vote
SUBJECT : Maternity services
SOURCE : California Commission on the Status of Women
DIGEST : This bill requires every individual or group
health insurance policy, as specified, to cover maternity
services, as defined.
Senate Floor Amendments of 9/4/09 (1) require a health
insurer, in regard to any pending or approved individual or
group health insurance policy form on file with the
Department of Insurance (CDI) as of January 1, 2010, to
submit revised policy forms by March 1, 2010 to CDI
CONTINUED
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indicating that said policies provide coverage for
maternity services, (2) require new forms of individual or
group health insurance policies submitted to CDI after
January 1, 2010, to include provision of maternity
services, and (3) make other technical and clarifying
changes.
ANALYSIS : Existing federal law, under the Federal Civil
Rights Act, requires employers that offer health insurance,
and have 15 or more employees, to cover maternity services
benefits at the same level as other health care benefits.
Existing state law:
1. Provides for the regulation of health plans by the
Department of Managed Health Care (DMHC) and for the
regulation of health insurers by CDI.
2. Requires health plans regulated by DMHC to provide all
medically necessary basic health care services, as
defined.
3. Specifies that basic health care services include
maternity services necessary to prevent serious
deterioration of the health of the enrollee or the
enrollee's fetus, and preventive health care services,
specifically including prenatal care. No similar
provision is applicable to health insurers regulated by
CDI.
4. Prohibits health plans and health insurers from issuing
contracts and policies that contain a co-payment or
deductible for inpatient hospital or ambulatory care for
maternity services that exceeds the most common amount
charged for the same type of care and service provided
for other covered medical conditions.
5. Existing law prohibits health plans and health insurers
who are providing maternity benefits, for a person
covered continuously from conception, from attaching any
exclusions, reductions, or limitations to coverage for
involuntary complications from pregnancy, unless these
provisions apply to all of the benefits paid by the plan
or insurer.
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This bill:
1. Requires, with respect to a pending or approved
individual or group health insurance policy form on file
with CDI as of January 1, 2010, a health insurer to
submit to CDI, on or before march 1,2 010, a revised
policy form that provides coverage for maternity
services. The corresponding policy issued, amended, or
renewed on or after 30 days following CDI's approval of
the revised form shall include coverage for maternity
services. New forms for individual or group policies of
health insurance submitted to CDI after January 1, 2010,
shall provide coverage for maternity services.
2. Defines maternity services to include prenatal care,
ambulatory care maternity services, involuntary
complications of pregnancy, neonatal care, and inpatient
hospital maternity care, including labor and delivery
and postpartum care.
3. Exempts from the provisions of this bill specialized
health insurance, Medicare supplement insurance,
short-term limited duration health insurance,
vision-only, or Civilian Health and Medical Program of
the Uniformed Services (CHAMPUS) supplement insurance,
TRI-CARE supplement insurance, hospital indemnity,
accident-only, and specified disease insurance.
4. Finds and declares that it is essential to clarify that
all health coverage made available to California
consumers, whether issued by health plans regulated by
the DMHC or disability insurers who sell health
insurance (health insurers) regulated by CDI, must
include maternity services.
Comments
This bill is virtually identical to two bills that Governor
Schwarzenegger vetoed in the last four years. In his veto
message of AB 1962 (De La Torre) 2007-08 Session, Governor
Schwarzenegger stated:
"This bill is nearly identical to a measure I vetoed in
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2004. My concerns with this bill remain unchanged. A
mandate, no matter how small, will only serve to increase
the overall cost of health care. I want to decrease the
number of uninsured Californians.
"Increasing the cost of coverage moves in the opposite
direction. The choice is difficult - protect access to
affordable health insurance when costs continue to
increase for employers and individuals - or mandate that
every person who pays for their own health insurance must
buy coverage for maternity services.
"Until the goals of prevention, affordability and the
concept of shared responsibility are addressed through
comprehensive health care reform, I must continue to veto
one-sided mandates that only increase costs to the
overall health care system."
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 9/8/09)
California Commission on the Status of Women (source)
American Civil Liberties Union
American College of Obstetricians and Gynecologists,
District IX
American Federation of State, County and Municipal
Employees
Blue Shield of California
California Academy of Family Physicians
California Association of Physician Groups
California Children's Hospital Association
California Communities United Institute
California Immigrant Policy Center
California Maternal Child and Adolescent Health Directors
California Medical Association
California National Organization for Women
California Nurse Midwives Association
California Nurses Association
California School Employees Association
California Teachers Association
California Women, Infants, and Children (WIC) Association
City of West Hollywood
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Congress of California Seniors
Having Our Say Coalition
Health Access California
Kaiser Permanente
Latino Coalition for a Healthy California
Latino Health Alliance
Latino Health Coalition
Los Angeles Best Babies Network
March of Dimes
Maternal and Child Health Access
Planned Parenthood Affiliates of California
Planned Parenthood, Mar Monte
Planned Parenthood, Six Rivers
The Women's Foundation of California
OPPOSITION : (Verified 9/8/09)
Anthem Blue Cross
Association of California Life and Health Insurance
Companies
California Association of Health Underwriters
California Chamber of Commerce
Department of Finance
Department of Managed Health Care
Irvine Chamber of Commerce
National Federation of Independent Business
ARGUMENTS IN SUPPORT : The bill's sponsor, the California
Commission on the Status of Women, writes that women should
not have to pay more for what amounts to essential medical
care, and this bill will ensure fair, affordable access to
maternity coverage in all health insurance policies. The
American College of Obstetricians and Gynecologists,
District IX, asserts that women should not be required to
pay significantly more for coverage for their basic medical
needs that are part of their biology and such gender
discrimination is exacerbated by a lesser ability to pay
for these policies when women still earn less than 80 cents
on the dollar, of that of men.
The California Medical Association and the California
Association of Physician Groups point out that reproductive
health coverage is preventive medicine that, in its
absence, can pose significant health problems for both the
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mother and baby. The California Academy of Family
Physicians writes that women will never need treatment for
prostate cancer, as men will never need treatment for
cervical cancer, and childless couples will never need
pediatric care; the point of insurance is to pool resources
and risk, share the cost of medical care, and protect
individuals from financial harm due to a medical condition.
Planned Parenthood writes that women who buy insurance
without maternity coverage may still find themselves in
need of this coverage, as almost half of all pregnancies
are unintended. Planned Parenthood writes that a woman
with late or no prenatal care is three times more likely
than normal to have a premature baby.
Blue Shield of California notes that, while it does not
generally support benefit mandates, the practice of
allowing insurers to offer individual policies without
maternity coverage undermines a basic purpose of insurance,
which is to spread treatment costs for fundamental health
care services over a large population, keeping costs
reasonable for all. Blue Shield notes that only one
segment of the market is permitted to escape the
requirement to provide maternity services, and this bill
closes that loophole.
ARGUMENTS IN OPPOSITION : The Association of California
Life and Health Insurance Companies (ACLHIC) writes that
forcing people to buy a benefit that might cause them to
drop coverage altogether seems counterproductive to the
shared goal of reducing the number of uninsured. ACLHIC
notes that approximately 93 percent of births in California
are covered by some form of insurance and current law also
ensures maternity benefits are offered on the same terms
and conditions as other health benefits, so there is no
consumer equity issue that needs to be addressed. ACLHIC
expresses concern that the mandate could put increased
pressure on the state budget through uncompensated
emergency room care by uninsured persons.
Anthem Blue Cross (BC) writes that, by eliminating choice,
this bill negatively impacts women and men who have made a
conscious decision not to buy maternity services, or women
who are unable to have children, by forcing them to
purchase coverage for services they do not want or need.
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BC notes that it provides the ability for members to shift
from non-maternity products to maternity products if the
member does become pregnant. BC believes that 805,000
individuals, including 461,000 Blue Cross members, who have
purchased coverage without maternity benefits are at risk
of premium increases of up to 107 percent, as a result of
the mandate, and that 10,000 Blue Cross members will drop
coverage.
The National Federation of Independent Business objects to
this bill because it would significantly increase the cost
of individual health care policies which are a major
vehicle for small business owners and others who do not
have employer-based coverage. The California Association
of Health Underwriters states that it can attest to the
price-sensitivity of young Californians, and that this bill
would drive young women from coverage and cause many
thousands more to move to higher deductible plans.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Coto, Davis, De La Torre, De Leon, Eng, Evans, Feuer,
Fong, Fuentes, Furutani, Galgiani, Hall, Hayashi,
Hernandez, Hill, Huber, Huffman, Jones, Krekorian, Lieu,
Bonnie Lowenthal, Ma, Mendoza, Monning, Nava, John A.
Perez, V. Manuel Perez, Portantino, Price, Ruskin, Salas,
Saldana, Skinner, Solorio, Swanson, Torlakson, Torres,
Torrico, Yamada, Bass
NOES: Adams, Anderson, Tom Berryhill, Blakeslee, Conway,
Cook, DeVore, Duvall, Fletcher, Fuller, Gaines, Garrick,
Gilmore, Hagman, Harkey, Jeffries, Knight, Logue, Miller,
Nestande, Niello, Nielsen, Silva, Smyth, Audra
Strickland, Tran, Villines
NO VOTE RECORDED: Bill Berryhill, Block, Emmerson
CTW/DLW/RJG:mw 9/8/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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