BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 513|
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THIRD READING
Bill No: AB 513
Author: De Leon (D), et al
Amended: 9/1/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-3, 7/15/09
AYES: Alquist, Cedillo, DeSaulnier, Leno, Pavley, Wolk
NOES: Strickland, Aanestad, Cox
NO VOTE RECORDED: Maldonado, Negrete McLeod
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 : 50-28, 6/2/09 - See last page for vote
SUBJECT : Health care coverage: breast-feeding
SOURCE : California WIC Association
DIGEST : This bill requires health care service plan
contract and health insurance policy issued, renewed, or
amended on or after January 1, 2010, that provides
maternity coverage to provide coverage for lactation
consultation with a lactation consultant and for provisions
of a personal electric or personal manual breast pump or
coverage for the rental of a hospital grade electric breast
pump.
CONTINUED
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ANALYSIS : Existing law, the Knox-Keene Health Care
Service Plan Act of 1975 (Knox-Keene Act), provides for the
licensure and regulation of health care service plans by
the Department of Managed Health Care and makes a willful
violation of that act a crime. Existing law also provides
for the regulation of health insurers by the Department of
Insurance. Under existing law, health care service plans
and health insurers are required to offer specified types
of coverage as part of their health care services plan
contracts or health insurance policies. Existing law
imposes specified requirements upon a health care service
plan contract or health insurance policy that provides
maternity coverage.
This bill requires specified health care service plans and
health insurers to include coverage for lactation
consultation (LC) and for the provision of a personal
electric or personal manual breast pump of coverage for the
rental of a hospital grade electric breast pump, as
defined, as part of their health care service plan
contracts or health insurance policies that provide
maternity coverage.
Comments
The author's office points out that breast-feeding has been
well established as a low-cost, low-tech preventive
intervention with far-reaching benefits for mothers and
babies and significant cost savings for health providers.
The author's office notes that exclusive breast-feeding for
three months has been shown to reduce health care costs for
infants in the first year of life alone by up to $475,
compared to non-breast-fed infants; and, LC provided by an
international board certified lactation consultant has been
shown to help women address the difficulties with initial
and continued breast-feeding. The author's office asserts
that the coverage of LC and breast pump rentals required by
this bill will provide breast-feeding mothers with the
support and skilled assistance they need to ensure that
feeding gets off to a good start.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
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According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11
2011-12 Fund
DMHC start-up $50 $0 $0 Special*
CalPERS benefits $50 $100 $100
General/**
Special/
Private
*Managed Care Fund
***Each state agency pays its employees premiums to CalPERS
out of its budget. Approximately 55 percent of employee
premiums are from the General Fund and 45 percent are from
other state funds. These other funds are made up of
approximately 67 percent special funds and 33 percent
moneys from other sources such as federal funds.
SUPPORT : (Verified 9/1/09)
California Women, Infant Children Association (source)
American Federation of State, County and Municipal
Employees
American Red Cross
Beach Cities Health District
Breastfeeding Task Force of Greater Los Angeles
California Breastfeeding Coalition
California Center for Public Health Advocacy
California Communities United Institute
California Food Policy Advocates
California Medical Association
California Nurses Association
Children's Hospital of Central California
Consumer Action
First 5 LA
First 5, Fresno County
First Five Santa Clara County
Healthcare Professionals
Inland Empire Breastfeeding Coalition
LA Best Babies Network
Planned Parenthood
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Prevention Institute
San Diego County Breastfeeding Coalition of 9 to 5 National
Assoc. of
Working Women
State of California, Commission on the Status of Women
The American College of Obstetricians and Gynecologists CA
Chapter
Tulare County Breastfeeding Coalition
United Nurses Association of California
University of California, San Diego
OPPOSITION : (Verified 9/1/09)
Anthem Blue Cross
Association of California Life & Health Insurance Companies
Cal Chamber
California Association of Health Plans
Department of Finance
Department of Health Care Services
Dept of Managed Health Care
Health Net
ARGUMENTS IN SUPPORT : The sponsor of this bill, the
California Women, Infants and Children Association, notes
in support that 87 percent of California mothers initiate
breast-feeding in the hospital and this bill will ensure
that, in the early days and weeks after birth, mothers will
receive the help they need to solve normal and expected
problems so they can continue breast-feeding, exclusively,
without the need for formula. Supporters, representing
health providers, public health groups, and breast-feeding
advocacy groups, assert that mothers should have access to
the support and tools they need to ensure that
breast-feeding is successful. Supporters add that the
minimal costs associated with these services should be more
than offset by the reduction of medical conditions in
infants needing medical treatment.
ARGUMENTS IN OPPOSITION : Health plans, health insurers,
and business groups generally object to all benefit
mandates because, while they sympathize with the intent to
meet a need, mandates increase the already high cost of
care for everyone and hinder a carrier's ability to offer a
wider range of affordable products, which together may lead
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individuals and employers to drop coverage. Health Net
contends that it already provides coverage for breast pumps
as part of durable medical equipment when there is a
demonstrated medical necessity and opposes this bill
because it requires coverage of pumps when they are not
needed for medical reasons but to assist the mother in
expressing milk on a schedule that is suitable for her.
Health Net also notes that most enrollees receive LC,
primarily from nurses, during delivery admission, and it is
not aware of any evidence that challenges the competence of
nurses to provide this assistance to new mothers.
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, Emmerson, 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
JJA:do 9/1/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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