BILL ANALYSIS Ó
AB 1954
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Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 1954
Burke - As Amended April 13, 2016
SUBJECT: Health care coverage: reproductive health care
services.
SUMMARY: Creates the Direct Access to Reproductive Health Care
Act which prohibits health care service plans or health
insurance policies from requiring an enrollee or insured to
receive a referral before receiving coverage of services for
reproductive or sexual health care. Specifically, this bill:
1)Prohibits health care service plans (health plans) or health
insurance policies from requiring an enrollee or insured to
receive a referral prior to receiving coverage of services for
reproductive and sexual health care.
2)Defines reproductive and sexual health care as all
reproductive and sexual health services for minors as
specified, including the prevention and treatment of
pregnancy, and the diagnosis and treatment of an infectious,
contagious, or communicable disease, and obtained by a patient
at or above the minimum age as specified.
3)Exempts specialized health care service plan contracts or any
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health care service plan that is governed by the Medi-Cal
Benefits Program.
EXISTING LAW:
1)Establishes the Department of Managed Care (DMHC) to regulate
health plans under the Knox-Keene Health Care Service Plan Act
of 1975, the Department of Insurance (CDI) to regulate health
insurers under the Insurance Code.
2)Requires DMHC to develop and adopt regulations for timeliness
of access to care, and requires contracts between health care
service plans and providers ensure compliance with those
standards.
3)Requires health plans to include obstetrician-gynecologists as
eligible primary care physicians, provided they meet the
health plan's eligibility criteria for all specialists seeking
primary care physician status.
4)Provides an enrollee the option to seek obstetrical and
gynecological physician services directly from a participating
obstetrician and gynecologist or directly from a participating
family practice physician and surgeon designated by the health
plan as providing obstetrical and gynecological services.
5)Establishes the Medi-Cal program, which is administered by the
State Department of Health Care Services (DHCS), under which
qualified low-income persons receive health care benefits and,
in part, governed and funded by federal Medicaid program
provisions.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
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1)PURPOSE OF THIS BILL. According to the sponsor, California
Family Health Council (CFHC), this bill seeks to prohibit
health plans from requiring a referral prior to patient
accessing essential sexual and reproductive health care
services. CFHC states that for many women, reproductive
health care is primary care and the inability to access
comprehensive reproductive and sexual health services in a
timely manner can lead to negative health outcomes including
increased risk for unintended pregnancy, sexually transmitted
diseases and delayed care. CFHC state that nearly
three-quarters of women of reproductive age in the nation
receive at least one sexual or reproductive service each year.
This bill allows patients in commercial health plans to
obtain family planning and sexual health services without
referrals from other providers, including advanced practice
clinicians, like nurse practitioners and certified
nurse-midwives. It is hereby the intent of the Legislature in
enacting this act to build on current state and federal law to
increase timely, equal, and direct access to time-sensitive
and comprehensive reproductive and sexual health care services
for enrollees in health care service plans or insureds under
health insurance policies
2)BACKGROUND. California has a long history of, and commitment
to, expanding access to services that aim to reduce the risk
of unintended pregnancies, improve reproductive and sexual
health outcomes, and reduce costs. The Legislature has also
passed measures to help health plan enrollees and insureds
access timely health care by setting standards and policies
regarding wait times for an appointment. According to the
Guttmacher Institute, one-half of all pregnancies in the
United States each year, more than three million pregnancies,
are unintended. By 45 years of age, more than one-half of all
women in the United States will have experienced an unintended
pregnancy, and three in 10 will have had an abortion. The
inability to access comprehensive reproductive health care in
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a timely manner can lead to negative health outcomes including
increased risk for unintended pregnancy, sexually transmitted
diseases, and delayed care for critical and time-sensitive
reproductive health services. Providing timely access to
comprehensive reproductive health services is cost effective.
California Health Benefits Review Program (CHBRP) analysis.
AB 1996 (Thomson), Chapter 795, Statutes of 2002, requests the
University of California to assess legislation proposing a
mandated benefit or service and prepare a written analysis
with relevant data on the medical, economic, and public health
impacts of proposed health plan and health insurance benefit
mandate legislation. CHBRP was created in response to AB
1996. SB 125 (Hernandez), Chapter 9, Statutes of 2015, added
an impact assessment on essential health benefits, and
legislation that impacts health insurance benefit designs,
cost sharing, premiums, and other health insurance topics.
The Committee requested a CHBRP analysis on this bill without
the most recent amendments; therefore the findings of CHBRP
are not relevant to this bill.
3)SUPPORT. CFHC, sponsor of this bill, writes that commercial
plans operating in California vary in terms of referral
policies and this variance has created a patchwork of coverage
and access to time-sensitive reproductive health services.
The CFHC also states that requiring referrals triggers
potential confidentiality concerns that lead to further delays
in obtaining care and for women seeking abortion services,
delays in referrals can delay them from receiving
time-sensitive information and services. Finally, CFHC notes
that this bill would remove unnecessary administrative burdens
that cause delays in care, and level the playing field to
create greater, more equitable access to services without
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referrals. California Primary Care Association writes that
for many women, reproductive health care is primary care. The
Community Clinic Association of Los Angeles County states that
this bill would build upon current state and federal law to
increase timely and direct access to comprehensive
reproductive and sexual health care services. The National
Association of Social Workers states that the inability to
access high quality, comprehensive reproductive health care in
a timely manner can lead to negative outcomes.
4)OPPOSITION. California Association of Health Plans, the
Association of California Life and Health Insurance Companies,
and America's Health Insurance Plans (AHIP) contend that
health insurance mandates threaten efforts of all health care
stakeholders to provide consumers with meaningful health care
choices and affordable coverage options. They state that the
Patient Protection and Affordable Care Act requires the state
to pay for the increased costs associated with the mandate for
those enrollees who purchase health insurance on the Exchange.
They also state that benefit mandates eliminate the ability
of health insurers and HMOs to provide unique benefit packages
aimed at the needs of consumers by requiring individuals and
employers to purchase benefits prescribed by the Legislature,
not driven by consumer choice. Finally, they note that health
benefit mandates stifle the use of innovative, evidence based
medicine. Additionally, AHIP writes that California already
requires direct access to obstetricians and gynecologists for
all women's health care services, including reproductive and
sexual health care services.
The California Catholic Conference (CCC) states that this bill
goes a step further than current law in reducing the standard
of health care for women and girls because it would bypass the
referral process in the health care system. The CCC states
that this bill would not be in the best interest of women,
nonetheless young girls who are generally less informed about
their own reproductive and sexual health care. The California
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Right to Life Committee, Inc. states that this bill appears to
be an attempt to secure a prominent position for Planned
Parenthood and is detrimental to women's and children's
health, irresponsible spending of health care dollars and an
actual barrier to the betterment of lives.
5)RELATED LEGISLATION. SB 999 (Pavley) would require
DMHC-regulated plans or CDI-regulated policies issued,
amended, renewed or delivered on or after January 1, 2017, to
cover a 12-month supply of Food and Drug Administration
(FDA)-approved, self-administered hormonal contraceptives
dispensed at one time to an enrollee. SB 999 is pending in
the Senate Appropriations Committee.
6)PREVIOUS LEGISLATION.
a) SB 1053 (Mitchell), Chapter 576, Statutes of 2014,
requires a health care service plan contract or health
insurance policy issued, amended, or renewed on or after
January 1, 2016, to provide coverage for women for all
prescribed and FDA-approved female contraceptive drugs,
devices, and products, as well as voluntary sterilization
procedures, contraceptive education and counseling, and
related follow-up services. Prohibits a nongrandfathered
plan contract or health insurance policy from imposing any
cost-sharing requirements or other restrictions or delays
with respect to this coverage, as specified.
b) SB 493 (Hernandez), Chapter, 469, Statutes of 2013,
authorizes advanced practice pharmacists to perform other
functions, including, among other things, furnishing
self-administered hormonal contraceptives, nicotine
replacement products, and prescription medications not
requiring a diagnosis that are recommended for
international travelers, as specified.
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7)APPLICATION OF THIS BILL. As currently drafted, this bill
appears to only apply to minors, however, reproductive and
sexual health care services is a concern for all. The
Committee may wish to ask the author on whether she intends to
broaden the application of this bill.
REGISTERED SUPPORT / OPPOSITION:
Support
California Family Health Council (co-sponsor)
California Latinas for Reproductive Justice (co-sponsor)
ACT for Women and Girls
Anti-Defamation League
Bayer
Black Women for Wellness
California Immigrant Policy Center
California Primary Care Association
Community Clinic Association of Los Angeles County
Forward Together
HIVE
Latino Coalition for a Healthy California
Law Students for Reproductive Justice
Maternal and Child Health Access
NARAL Pro-Choice California
National Association of Social Workers, California Chapter
Northeast Valley Health Corporation
Physicians for Reproductive Health
URGE: Unite for Reproductive & Gender Equity
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Women's Health Specialists of California
Opposition
America's Health Insurance Plans
Association of California Life and Health Insurance Companies
California Association of Health Plans
California Catholic Conference
Analysis Prepared by:Kristene Mapile / HEALTH / (916) 319-2097