BILL ANALYSIS �
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THIRD READING
Bill No: AB 2X1
Author: Pan (D)
Amended: 4/1/13 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-1, 4/10/13
AYES: Hernandez, Anderson, Beall, De Le�n, DeSaulnier, Monning,
Pavley, Wolk
NOES: Nielsen
SENATE APPROPRIATIONS COMMITTEE : 7-0, 4/15/13
AYES: De Le�n, Walters, Gaines, Hill, Lara, Padilla, Steinberg
ASSEMBLY FLOOR : 53-25, 2/28/13 - See last page for vote
SUBJECT : Health care coverage
SOURCE : Author
DIGEST : This bill reforms Californias individual market in
accordance with the federal Patient Protection and Affordable
Care Act (ACA) and applies its provisions to insurers regulated
by the Department of Insurance (DOI) in the individual market;
requires guaranteed issue of individual market health insurance
policies; prohibits the use of preexisting condition exclusions;
establishes open and special enrollment periods consistent with
the California Health Benefit Exchange (Covered California);
prohibits conditioning issuance or offering based on specified
rating factors; prohibits specified marketing and solicitation
practices consistent with small group requirements; requires
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guaranteed renewability of plans; and permits rating factors
based on age, geographic region and family size only. Makes
conforming changes to California's small group law enacted in
AB 1083 (Monning, Chapter 852, Statutes of 2012).
ANALYSIS :
Existing federal law:
1. Establishes the ACA, which imposes various requirements on
states, issuers, employers, and individuals regarding health
care coverage.
2. Requires each health insurance issuer that offers coverage in
the individual or group market to accept every employer and
individual that applies for that coverage and to renew that
coverage at the option of the employer or the individual.
This is known as guaranteed issue and guaranteed
renewability.
3. Prohibits a group health plan and a health insurance issuer
offering group or individual health insurance coverage from
imposing any preexisting condition exclusion with respect to
that plan or coverage.
4. Allows the premium rate charged by a health insurance issuer
offering small group or individual coverage to vary only as
specified, and prohibits discrimination against individuals
based on health status.
5. Defines "grandfathered plan" as any group or individual
health insurance product that was in effect on March 23,
2010.
Existing state law:
1. Provides for regulation of health insurers by DOI under the
Insurance Code and provides for the regulation of health
plans by the Department of Managed Health Care (DMHC)
pursuant to the Knox-Keene Health Care Service Plan Act of
1975, collectively referred to as insurers. This bill
applies to insurers regulated by DOI.
2. Establishes Covered California, to facilitate the purchase of
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Qualified Health Plans (QHPs) through Covered California by
qualified individuals and qualified small employers by
January 1, 2014.
3. Requires, as a condition of participation in Covered
California, insurers that sell any products outside Covered
California to fairly and affirmatively offer, market, and
sell all products made available in Covered California to
individuals and small employers purchasing coverage outside
of Covered California.
4. Requires health plans to fairly and affirmatively offer,
market, and sell health coverage to small employers, known as
"guaranteed issue."
5. Defines a preexisting condition provision as a contract
provision that excludes coverage for charges or expenses
incurred during a specified period following the employee's
effective date of coverage, as a condition for which medical
advice, diagnosis, care, or treatment was recommended or
received during a specified period immediately preceding the
effective date of coverage.
6. Prohibits a plan contract for group coverage from imposing
any preexisting condition provision upon any child under 19
years of age.
7. Prohibits a plan contract for individual coverage that is not
a grandfathered health plan, as defined by the ACA, from
imposing any preexisting condition provision upon any
children under 19 years of age.
8. Prohibits, with respect to the individual market coverage for
children, except to the extent permitted by federal law,
insurers from conditioning the issuance or offering of
individual coverage on certain factors.
9. Defines a "rating period."
10.Establishes risk categories for rating purposes in the small
group market and specifies age categories, family size
categories, and up to nine geographic regions, as determined
by the insurers.
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11.Prohibits a plan in the small group market from, directly or
indirectly, entering into any contract, agreement, or
arrangement with a solicitor that provides for or results in
the compensation paid to a solicitor for the sale of a health
plan contract to be varied because of the health status,
claims experience, industry, occupation, or geographic
location of the small employer.
12.Prohibits a policy or contract that covers two or more
employees from establishing rules for eligibility, including
continued eligibility of an individual or dependent of an
individual, to enroll under the terms of the plan based on
health status-related factors, as defined.
Specifics of AB 2X1
This bill:
1. Prohibits an insurer (except grandfathered plans, as
specified) from imposing any preexisting condition provision
upon any individual.
2. Requires guaranteed issue of individual market health
insurance policies.
3. Requires insurers to fairly and affirmatively offer, market,
and sell all of the insurer's health benefit plans that are
sold in the individual market to all individuals in each
service area in which the insurer provides or arranges for
the provision of health care services.
4. Requires an insurer to provide an initial open enrollment
period from October 1, 2013, to March 31, 2014, inclusive,
and after January 1, 2015, annual enrollment periods from
October 15 to December 7, inclusive of the preceding calendar
year.
5. Requires insurers to set premium rates based only on the
following:
A. Age, using age bands established by the Secretary of
Health and Human Services (HHS) and the age-rating curve
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established by the Centers for Medicare & Medicaid
Services;
B. Geographic region as described in #23 below; and
C. Whether the contract covers an individual or family, as
defined in the ACA.
6. Requires an insurer to allow an individual to enroll in or
change individual health benefit plans as a result of the
following triggering events:
A. Loses minimum essential coverage (MEC), as defined in
the Internal Revenue Code, as specified. Loss of MEC does
not include loss of that coverage due to the individual's
failure to pay premiums on a timely basis, or situations
allowing for a rescission;
B. Gains a dependent or becomes a dependent through
marriage, birth, adoption, or placement for adoption;
C. Becomes a resident of California;
D. Released from incarceration;
E. Health benefit plan substantially violated a material
provision of the contract;
F. Gains access to a new health benefit plan as a result
of a move; or
G. Meets any of the requirements listed in federal
regulations, as specified, with respect to individual
health benefit plans offered through Covered California.
7. Establishes, for special enrollment effective dates, coverage
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to be effective no later than the first day of the first
calendar month beginning after the date the plan receives the
request, except in the case of birth, adoption, or placement
for adoption, which is the effective date of the birth,
adoption, or placement for adoption.
8. Requires an individual, with respect to plans offered inside
or outside Covered California, to have 60 days from the date
of a triggering event identified above to apply for coverage.
9. Requires an insurer, with respect to individual health plans
offered outside Covered California, after an individual
submits a completed application form for a plan, to notify
the individual of the individual's actual premium charges for
that plan within 30 days. Requires the individual to have 30
days in which to exercise the right to buy coverage at the
quoted premium charges.
10.Prohibits an insurer from conditioning the issuance or
offering of an individual health benefit plan on any of the
following factors:
A. Health status;
B. Medical condition, including physical and mental
illness;
C. Claims experience;
D. Receipt of health care;
E. Medical history;
F. Genetic information;
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G. Evidence of insurability, including conditions arising
out of acts of domestic violence;
H. Disability; and
I. Any other health status-related factor as determined by
federal regulations, rules, or guidance.
11.Requires an insurer to consider the claims experience of all
insured in its non-grandfathered individual health benefit
plans to be part of a single-risk pool and to consider the
claims experience of all insured in non-grandfathered small
employer health benefit plans to be part of another
single-risk pool. Student health coverage is exempt from the
risk-pool requirements.
12.Requires all individual health plans to conform to specified
requirements, and to be renewable at the option of the
enrollee except as permitted to be canceled, rescinded, or
not renewed, as specified. Requires any plan that ceases to
offer for sale new individual health benefit plans, as
specified, to continue to be governed by specified law with
respect to business conducted under the specified law.
13.Permits an insurer to vary premium rates for a particular
plan from its index rate based only on the following
actuarially justified plan-specific factors:
A. The actuarial value and cost-sharing design of the
health benefit plan;
B. The health benefit plan's provider network, delivery
system characteristics, and utilization management
practices;
C. The benefits provided by the insurer that are in
addition to the essential health benefits (EHB). These
additional benefits are required to be pooled with
similar benefits within a single-risk pool and the
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claims experience from those benefits to be utilized to
determine rate variations for plans that offer those
benefits in addition to EHB; and
D. With respect to catastrophic plans, the expected
impact of the specific eligibility categories for those
plans.
14.Modifies the exceptions from the guaranteed issue requirement
in existing small group law and the manner in which an
insurer determines premium rates for a small employer health
benefit plan, as specified.
Non-conforming provisions:
15.Repeals existing law that would have required the rate for
any child to be identical to the standard-risk rate.
16.Sunsets existing law, on December 31, 2013, related to rating
categories for child coverage.
17.Exempts grandfathered plans from the ACA requirements as
allowed under federal law.
18.Modifies the small employer special enrollment periods and
coverage-effective dates for purposes of consistency with the
draft federal rules.
19.Adds the following triggering events that will require a plan
or insurer to allow an individual to enroll in or change
individual health benefit plans, as a result of the
following:
A. Receiving services from a contracting provider and
that provider is no longer participating in the health
benefit plan;
B. Demonstrates that they did not enroll during the
available enrollment period because they were
misinformed about MEC; or
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C. Being a member of the reserve forces of the United
States military returning from active duty or a member
of the California National Guard returning from active
duty service.
20.Prohibits an insurer, solicitor, agent or broker from,
directly or indirectly, engaging in the following activities:
A. Encouraging or directing an individual to refrain
from filing an application for individual coverage with
a plan because of the health status, claims experience,
industry, occupation, or geographic location, provided
that the location is within the plan's approved service
area; and
B. Encouraging or directing an individual to seek
individual coverage from another plan or health insurer
or Covered California because of the health status,
claims experience, industry, occupation, or geographic
location, provided that the location is within the
plan's approved services area.
21.Prohibits an insurer, from directly or indirectly, entering
into contracts, agreement, or arrangement with a solicitor,
agent or broker that provides for or results in the
compensation paid to a solicitor for the sale of an
individual health benefit plan to be varied because of health
status, claims experience, industry, occupation, or
geographic location of the individual. Does not apply to a
compensation arrangement that provides compensation to a
solicitor, agent or broker on the basis of percentage of
premium, provided that the percentage cannot vary because of
the health status, claims experience, industry, occupation,
or geographic area.
22.Prohibits tobacco use from being a rating factor.
23.Establishes 19 rating regions, which were approved by the
Center for Consumer Information and Insurance Oversight on
April 1, 2013.
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24.Requires, by June 1, 2017, DMHC, Covered California and DOI,
to review the geographic rating regions and the impacts of
those regions on the health care coverage market in
California, and submit a report to the appropriate policy
committees of the Legislature.
25.Requires insurers to provide specified information regarding
Covered California to applicants for products offered outside
Covered California.
26.Prohibits insurers from advertising or marketing an
individual grandfathered health plan for the purpose of
enrolling a dependent of the subscriber or policyholder in
the plan.
27.Requires insurers to annually issue a specified notice to
those enrolled in a grandfathered plan about the availability
of other health insurance options.
28.Prohibits an insurer from requiring an individual applicant
or his or her dependent to fill out a health assessment or
medical questionnaire prior to enrollment. Prohibits an
insurer from acquiring or requesting information that relates
to a health status-related factor from the applicant or
his/her dependent or any other source prior to enrollment.
29.Requires any data submitted by insurers to the United States
HHS Secretary for purposes of the risk adjustment program
required under the ACA to also be submitted to DOI. Allows
DOI to use this information to monitor federal implementation
of risk adjustment.
30.Authorizes an insurer to meet the current summary-benefit
disclosure requirements by providing the uniform summary of
benefits required by the ACA. Requires this information to
be submitted to DOI.
31.Requires the provisions of this bill to only be implemented
to the extent that it meets or exceeds the requirements set
forth in the ACA.
32.Repeals 12 months after the repeal of the federal individual
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mandate the following individual market provisions:
A. Guarantee Issue;
B. Prohibition on preexisting conditions;
C. Community rating; and,
D. Prohibition on eligibility rules based on health
status and other factors.
33.Repeals 12 months after the repeal of federal guaranteed
issue and federal community rating provisions the following
small group provisions:
A. Guaranteed Issue;
B. Community rating; and,
C. Prohibition on eligibility rules based on health
status and other factors.
34.Authorizes the Insurance Commissioner (IC) to adopt
regulations to implement the changes made by this bill
pursuant to the Administrative Procedures Act, as specified.
Requires the IC to consult with the Director of DMHC prior to
adopting any regulations for the purposes of ensuring
consistency of regulations.
BACKGROUND
Individual market . California's individual and small group
health insurance markets together currently serve just fewer
than 15% of the state's population, with approximately two
million people being covered through individually purchased
health insurance. In California, three insurers serve over 75%
of the market: Anthem Blue Cross PPO, Blue Shield PPO, and
Kaiser HMO. California's two regulators allow variation in
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product design. Plans under DMHC must provide a defined set of
basic health care services, while plans under DOI have more
flexibility and may offer slimmer benefits. DOI-regulated
products are far more prevalent in the individual market.
According to a 2011 report published by the California
HealthCare Foundation (CHCF), approximately 2 million
Californians are covered through individually purchased health
insurance. About 40% of current individual market purchasers
would likely qualify for subsidies and another 18% would be
eligible for Medicaid (Medi-Cal in California) if the ACA rules
were in effect today. There are between five and seven million
uninsured in the state and 39% (2.7 million) may be eligible for
Medi-Cal, half (3.5 million) may be eligible for subsidies to
purchase individual insurance, and 11% (800,000) will not likely
qualify for subsidies. More than one million of the uninsured
are undocumented immigrants, who will not qualify for subsidies
and will be excluded from Covered California.
At the time, CHCF found that individual premiums varied by age
as much as five-fold, meaning a 60-year old will pay five times
what a 25-year old might pay. However, there is evidence that
California's individual market premiums are already closer to
the 2014 allowable 3:1 ratio. For example, 2013 premium rate
filings for the Anthem Blue Cross three most popular
non-grandfathered product families all have age ratios below
3.9. In addition, 2013 premiums in the state high-risk pool,
the Major Risk Medical Insurance Program, which bases rates on
insurer filings of premiums for open market individual coverage,
have an age ratio for 64-year olds that range from 2.3 - 2.9,
depending on the health plan. In the CHCF report, premiums
ranged from $113 to $777 a month.
Individual market insurance provides less comprehensive
coverage, with CHCF reporting that individual coverage paid an
average of 55% of medical expenses, compared to 80 to 90% of
expenses for group coverage. Purchasers in the individual market
pay 100% of their coverage; the market is very price sensitive
and purchasers are medically screened by insurers concerned
about high-risk consumers buying and keeping coverage.
Small group market . AB 1672 (Margolin and Hansen, Chapter 1128,
Statutes of 1992), enacted a number of reforms to the small
group market, making health insurance more accessible to small
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employers through guaranteed issue and renewability provisions,
regulating preexisting conditions limitations, underwriting
protections, and disclosure requirements. Before AB 1672, an
insurer would examine an employer's health history and could
either increase the premiums significantly or decline the entire
group.
California's small group market has been shaped by guaranteed
issue and other protections established in small group reform in
1992. In this market, insurers may impose participation
requirements and contribution requirements. As a result,
enrollees in small group coverage typically pay a fraction of
their premium. A 2011 CHCF report indicates that 3.4 million or
9%, of Californians have health coverage through small group
insurance products. Roughly 67% of small group products are
regulated by DMHC, compared to 33 regulated by DOI.
The ACA eliminates the pricing of premiums based on health
status, limits the range of premiums based on age, adds the
self-employed to those eligible for guaranteed issue of
coverage, and expands the rules to small group employers with
one to 100 employees. AB 1083 established these reforms in
California's small group health insurance market. This bill
updates these reforms to be consistent with federal rules
released in November 2012.
Health Benefit Exchanges . The ACA requires each state, by
January 1, 2014, to establish an American Health Benefit
Exchange that makes QHPs available to qualified individuals and
qualified employers or a state may defer to the federal
government. Federal law establishes requirements for the
Exchange, for health plans participating in the Exchange, and
defines who is eligible to receive coverage in the Exchange.
Beginning January 1, 2014, individual taxpayers whose household
income equals or exceeds 100%, but does not exceed 400% of the
FPL, will receive a refundable tax credit for a percentage of
the cost of premiums for coverage under a qualified health plan.
The ACA also allows "qualified small employers" to elect a tax
credit worth up to 35% of a small business' health insurance
premium costs and establishes requirements for a qualifying
employer. The ACA also requires reductions in the maximum
limits for out-of-pocket expenses for individuals enrolled in
QHPs whose incomes are between 100% and 400% of the FPL.
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In 2010, California was the first state to create a state-based
exchange, today known as Covered California. State exchanges
are required to certify QHPs, operate a toll-free hotline and
Web site, rate QHPs, present plan options in a standard format,
inform individuals of the eligibility requirements for Medicaid
(Medi-Cal in California) and the Children's Health Insurance
Program (Healthy Families in California), provide an electronic
calculator to calculate plan costs, and grant certifications of
exemption from the individual requirement to have health
insurance.
According to Covered California's January 2013 annual report,
Covered California is currently in the process of choosing
health plan offerings and will begin testing the online
enrollment portal. Over the next few months, grants will be
awarded to community organizations for public awareness efforts,
and assisters will be trained to understand Covered California
enrollment offerings. In November 2012, Covered California
released its QHP solicitation and proposed regulations. Final
bids were submitted on March 1, 2013, and Covered California
anticipates it will conduct its selection and certification
process for QHPs in early to mid-2013 for pre-enrolment on
October 1, 2013.
Individual Mandate . The minimum essential coverage provision of
the ACA, known as the individual mandate, requires most people
to maintain a minimum level of health insurance coverage for
themselves and their tax dependents in each month beginning in
2014. The individual mandate can be satisfied by obtaining
coverage through employer-sponsored insurance, an individual
insurance plan including those to be offered through the new
health insurance exchanges, a grandfathered health plan,
government-sponsored coverage such as Medicare or Medicaid, or
similar federally recognized coverage. People exempt from the
individual mandate include undocumented immigrants, religious
objectors, and people who are incarcerated. There are also
income-related carve-outs. In 2014, people who choose not to
buy insurance and do not quality for an exemption from the
mandate will have to pay a fine of $95. The penalty increases
to $695 by 2016, and then rises annually based on a
pre-determined formula.
Final Federal Rule on 2014 Market Rules . On February 22, HHS
issued a final rule implementing several ACA health insurance
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market rules. Below is a summary of the final rules pertaining
to provisions in this bill.
Guaranteed Availability of Coverage -As of 2014, issuers
cannot decline coverage based on preexisting conditions or any
other health factor, and the availability of individual
policies will be guaranteed during open enrollment periods, as
well as when individuals experience qualifying events, similar
to the group market today. All policies in the group market
will be continuously available.
Insurance Premiums - Issuers may vary premiums only based on
age (within a 3:1 ratio for adults), tobacco use (within a
1.5:1 ratio for adults and subject to wellness program
requirements in the small group market), family size, and
geography. States can adopt more stringent rating criteria.
Guaranteed Renewability - Individuals' and employers' existing
coverage renewal protections while including several
additional consumer protections.
Single-Risk Pools - Issuers will maintain one statewide risk
pool for each of their individual and small employer markets,
unless a state chooses to merge the individual and small group
pools.
Geographic Rating Regions - The November 2012 proposed rule
had limited states to no more than seven rating areas based on
counties, three-digit zip codes, or metropolitan statistical
areas (MSAs) unless HHS permitted a different actuarially
justified approach. The final rule expands state discretion,
continuing to require rating areas to be based on counties,
three-digit zip codes, or MSAs, but permitting states to use
geographic rating areas legally established by January 1,
2013, or after January 1, 2013, as long as the number of
rating areas does not exceeding the number of MSAs in the
state plus one. States may still establish more geographic
rating areas with HHS approval.
Age Bands - For all states and markets a single age band for
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children 0 to 20, one-year age bands for adults 21 through 64,
and a single age band for adults 64 and older. Age will be
determined only once a year, at the time of policy issuance or
renewal. States may adopt their own age-rating curve, but for
states that fail to do so, HHS will adopt the default- rating
curve found in the proposed rule and a rating factor of .635
for children. This bill defers to the federal age-rating
curve.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee, one-time costs
of about $600,000 to the DOI to adopt regulations and review
health policy filings (Insurance Fund).
SUPPORT : (Verified 4/17/13)
100% Campaign
AARP
AFSME, AFL-CIO
American Cancer Society Cancer Action Network
American Heart Association
California Academy of Family Physicians
California Alliance for Retired Americans
California Chiropractic Association
California Federation of Teachers
California Healthcare Institute
California Optometric Association
California Pan-Ethnic Health Network
California Primary Care Association
California Public Interest Research Group
Congress of California Seniors
Consumers Union
Epilepsy California
Greenlining Institute
Health Access California
Latino Coalition for a Healthy California
National Association of Social workers, California Chapter
National Multiple Sclerosis Society - California Action Network
Transgender Law Center
United Nurses Associations of California/Union of Health Care
Professionals
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OPPOSITION : (Verified 4/17/13)
Department of Insurance
ARGUMENTS IN SUPPORT : According to the author's office, this
bill is necessary to bring California health insurance market
rules in line with the ACA. This bill also contains clean-up
provisions to AB 1083 which enacted insurance market reforms
consistent with the ACA affecting health insurance sold to small
employer purchasers. More significantly, this bill establishes
insurance market reforms consistent with the ACA affecting the
health insurance market for individual purchasers. These
reforms eliminate insurance industry practices of denying people
insurance who have preexisting medical conditions and charging
higher rates because of health history. It is necessary to put
the federal rules in state law for state regulatory enforcement
purposes. An important general objective of this ACA
state-implementing legislation is to ensure that the rules in
Covered California and outside Covered California, as well as in
both the small group and individual markets, are as similar as
possible in an effort to avoid adverse selection.
Clean-up provisions are necessary because new final federal
regulations have been issued which require updating of the AB
1083 provisions. In addition, while the Legislature approved AB
1461 (Monning) and SB 961 (Ed Hernandez) in 2012, which would
have established insurance market rules for individual
purchasers, those bills were vetoed by the Governor because a
provision to link or "tie back" state law to federal law was
viewed as insufficient. As a result, Covered California has
initiated a QHP solicitation process based on assumptions of
what might be the individual market rules in California. Health
insurers bidding to be QHPs must submit premium bids to Covered
California by March 31, 2013, in order to ensure they receive
regulatory review in time for Covered California to begin
marketing and offering those plans in October of 2013. The
rules established and revised by this bill would apply to health
insurance sold through Covered California as well as insurance
products sold in the commercial market outside of Covered
California, and need to be in place as soon as possible in time
for the regulatory reviews required for QHPs.
On January 24, 2013, Governor Brown issued a proclamation
convening an extraordinary session of the Legislature to
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consider and act upon legislation necessary to implement the ACA
in the areas of: (a) California's private health insurance
market, rules and regulations governing the individual and small
group market; (b) California's Medi-Cal program and changes
necessary to implement federal law; and, (c) options that allow
low-cost health coverage through Covered California to be
provided to individuals who have income up to 200% of the FPL.
This bill, along with SB 2 X1 (Hernandez), addresses the first
of the three areas identified in the Governor's proclamation.
Health Access California (HAC), a statewide health care consumer
advocacy coalition, writes in support stating this bill will
reform California's individual insurance market to provide
guaranteed issue and modified community rating. HAC writes that
the repeal or modification of the protections of the ACA are
highly unlikely and, if in the future, the ACA provisions on the
individual market are repealed or altered, the first choice
should not be to revert to the status quo ante in which
consumers may be denied health insurance for any reason or no
reason. The first choice should be to figure out a policy
response that protects consumers and gives them the opportunity
to obtain affordable coverage. Other states have done this, and
HAC argues California should protect its own consumers and do
the same.
HAC also supports the provision of this bill that limits rate
increases to once annually arguing consumers should be able to
budget and plan. HAC is concerned about the limits imposed on
guaranteed issue writing that people will not be able to get
coverage at any time but only during limited open enrollment
periods. While these restrictions will limit the availability
of coverage for Californians during much of the year, HAC
reluctantly accepts this given the federal rule on Exchanges
which impose the same rules.
The 100% campaign writes in support stating they are committed
to creating an equitable market for consumers and ensuring
standardized and consistent premium risk rating rules for
children with all types of health insurance coverage. The 100%
campaign also supports and appreciates the interim coverage
opportunities created for children and youth in advance of 2014.
California Public Interest Research Group writes in support of
this bill and the importance of ending denials for preexisting
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conditions and limiting the ability of insurers to charge
consumers different rates. The Transgender Law Center writes
that the bill contains multiple provisions that will optimize
coverage for all Californians. The Greenlining Institute states
this bill is of critical importance to communities of color who
suffer disproportionally from preventable chronic illnesses but
who are less likely to have health insurance. The Greenlining
Institute argues this bill will improve access to and
affordability of health insurance for communities of color.
AFSCME writes in support that this bill will help expand health
insurance coverage in the commercial market.
ARGUMENTS IN OPPOSITION : DOI writes that the selection of the
geographic rating regions is one of the most significant choices
the state has to make that will impact the affordability of
health insurance for consumers. DOI is greatly concerned that
geographic rating regions contained in AB 1083, will result in
premium increases and should not be adopted in this legislation.
DOI is proposing an alternative 18 geographic ratings region
proposal.
ASSEMBLY FLOOR : 53-25, 2/28/13
AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,
Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon,
Campos, Chau, Chesbro, Cooley, Daly, Dickinson, Eggman, Fong,
Fox, Frazier, Garcia, Gatto, Gomez, Gordon, Gray, Hall, Roger
Hern�ndez, Holden, Hueso, Jones-Sawyer, Levine, Lowenthal,
Medina, Mitchell, Mullin, Muratsuchi, Nazarian, Pan, Perea, V.
Manuel P�rez, Quirk, Quirk-Silva, Rendon, Salas, Stone, Ting,
Torres, Weber, Wieckowski, Williams, John A. P�rez
NOES: Achadjian, Allen, Bigelow, Ch�vez, Conway, Dahle,
Donnelly, Beth Gaines, Gorell, Grove, Hagman, Harkey, Jones,
Linder, Logue, Maienschein, Mansoor, Melendez, Morrell,
Nestande, Olsen, Patterson, Wagner, Waldron, Wilk
NO VOTE RECORDED: Skinner, Yamada
JL:d 4/17/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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