BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1208
AUTHOR: Pan
AMENDED: September 6, 2013
HEARING DATE: September 11, 2013
CONSULTANT: Bain
PURSUANT TO SENATE RULE 29.10.
SUBJECT : Insurance affordability programs: application form.
SUMMARY : Permits, until January 1, 2015, the application form
for insurance affordability program coverage to include
additional questions that are voluntary for applicants to answer
on sexual orientation and gender identity or expression.
Requires, by January 1, 2015, the application form to include
questions that are voluntary for applicants to answer regarding
demographic data categories, including race, ethnicity, primary
language, disability status, sexual orientation, gender identity
or expression and other categories recognized by the federal
Secretary of the Department of Health and Human Services.
Existing law:
1.Requires a single, accessible, standardized paper, electronic,
and telephone application for insurance affordability programs
to be developed by the Department of Health Care Services,
(DHCS) in consultation with the Managed Risk Medical Insurance
Board (MRMIB) and the board governing Covered California (the
state's health benefit exchange). Requires the application
form to be used by all entities authorized to make an
eligibility determination for any of the insurance
affordability programs and by their agents.
2.Defines "insurance affordability programs" as the Medi-Cal
program, the state's children's health insurance program
(CHIP, which is known as the Healthy Families Program in
California), and coverage through a qualified health plan in
Covered California with a premium tax credit or cost-sharing
reduction established under federal law.
3.Authorizes the form to include questions that are voluntary
for applicants to answer regarding demographic data
categories, including race, ethnicity, primary language,
disability status, and other categories recognized by the
Continued---
AB 1208 | Page 2
federal Secretary of the Department of Health and Human
Services (DHHS) pursuant to federal law.
This bill:
1.Authorizes, until January 1, 2015, the application form for
insurance affordability program coverage to include additional
questions that are voluntary for applicants to answer on
sexual orientation and gender identity or expression.
2.Requires, by January 1, 2015, the application form to include
questions that are voluntary for applicants to answer
regarding demographic data categories, including race,
ethnicity, primary language, disability status, sexual
orientation, gender identity or expression and other
categories recognized by the federal Secretary of the DHHS.
FISCAL EFFECT : According to the Senate Appropriations Committee
analysis of an identical provision in a different bill, one-time
costs of $100,000 to $150,000 to modify information technology
systems to allow the health care coverage application system for
Medi-Cal and the California Health Benefit Exchange to include
required demographic questions in the application (federal funds
or special funds).
PRIOR VOTES : Not relevant
COMMENTS :
1.Author's statement. This bill contains provisions related to
the collection of demographic data on the simplified
application for insurance affordability programs that is
required by the federal Patient Protection and Affordable Care
Act (ACA). The provisions were previously in AB 50 (Pan) but
deleted at the request of the Administration. The author
states that it is essential to continue to pursue this
provision as a stand-alone bill.
The collection of this demographic data is needed for two
reasons. The first is to assess and evaluate application and
program enrollment data to determine whether a particular
demographic category is underrepresented. This could be a
geographic region or a particular language or ethnic group.
Trends could be identified that would allow tailored outreach
strategies to target these underrepresented groups or areas.
Secondly, this data is needed to identify health disparities
by region and other demographic categories, such as gender
identify and language spoken. Currently only language spoken,
AB 1208 | Page
3
gender and ethnicity are being collected by the Medi-Cal
program. This bill is also a companion bill to AB 411(Pan)
will provide for a more detailed analysis of disparities among
these categories in the Medi-Cal managed care program. With
regard to Covered California, in order to meet the
requirements of the ACA and for the new system to be
operational by October 1, 2013, a decision was made to omit
these items from the initial system design. Therefore, this
bill does not mandate the collection until January 1, 2015.
However, this demographic information will be crucial and
therefore should begin to be collected in the future. It is
not sufficient to defer the collection of the data to the
health plans as there is no guarantee that it will be
collected and analyzed in order to identify and reduce health
disparities.
2.Background. ACA makes numerous changes to simplify enrollment
in public health coverage programs. ACA requires that an
enrollment system be created that allows state residents to
apply for enrollment, receive an eligibility determination,
and renew participation in state health subsidy programs. In
addition, ACA requires the Secretary of DHHS to develop and
provide to each state a single, streamlined form that:
§ May be used to apply for all applicable state health
subsidy programs (Medi-Cal, Healthy Families Program, and
through Covered California);
§ May be filed online, in person, by mail, or by
telephone;
§ May be filed with Covered California or with state
officials operating one of the other applicable state
health subsidy programs; and,
§ Is structured to maximize an applicant's ability to
complete the form satisfactorily, taking into account the
characteristics of individuals who qualify for applicable
state health subsidy programs.
1.Related legislation. AB 50 (Pan) originally contained the
provisions of this bill, among other changes. The provisions
contained in this bill was amended out of AB 50 through
amendments adopted on the Senate Floor on September 6, 2012,
which deleted the previous contents of AB 1208 that dealt with
medical homes.
2.Prior legislation. AB 1296 (Bonilla), Chapter 641, Statutes of
AB 1208 | Page 4
2011, the Health Care Eligibility, Enrollment, and Retention
Act, requires the California Health and Human Services Agency,
in consultation with other state departments and stakeholders,
to undertake a planning process to develop plans and
procedures regarding these provisions relating to enrollment
in state health programs and federal law. AB 1296 also
established the existing law requirements for the application
form for insurance affordability programs.
3.Support. This bill is sponsored by Equality California (EC),
which states a number of studies have indicated that members
of the lesbian, gay, bisexual and transgender (LGBT)
population continue to experience worse health outcomes than
their non-LGBT counterparts. Due to factors like low rates of
health insurance coverage, high rates of stress from
systematic harassment and discrimination, and a lack of
cultural competency in the health care system, LGBT people are
at a higher risk for cancer, mental illnesses, and other
diseases, and are more likely to smoke, drink alcohol, use
drugs, and engage in other risky behaviors. EC states it can
only estimate the full extent of LGBT health disparities due
to a consistent lack of data collection on sexual orientation
and gender identity.
EC writes that this bill will significantly help to address this
problem by requiring that data on sexual orientation and
gender identity that is voluntarily given be collected for the
purposes of various health insurance programs in the state.
This information will allow researchers and advocates to get a
fuller and more accurate accounting of LGBT health outcomes
and needs-and ultimately to close the gap between the health
and well-being of LGBT people and the non-LGBT population.
The California Pan-Ethnic Health Network (CPEHN) writes that
health disparities are prevalent and pervasive. To address
these disparities experienced by California's diverse
communities, CPEHN argues our state's health care programs
must improve the way in which we collect and analyze data by
enrollee demographics, including race, ethnicity, language and
sexual orientation. CPEHN argues this bill will help in this
effort by updating applications to include voluntary questions
on certain enrollee demographics.
SUPPORT AND OPPOSITION :
Support: Equality California (sponsor)
California Lesbian, Gay, Bisexual, and Transgender Health
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Human Services Network
California Pan-Ethnic Health Network
Transgender Law Center
Oppose: None received
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