BILL ANALYSIS Ó
SB 10
Page 1
SENATE THIRD READING
SB
10 (Lara)
As Amended May 27, 2016
2/3 vote. Urgency
SENATE VOTE: (vote not relevant)
--------------------------------------------------------------------
|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Health |12-3 |Wood, Bonilla, Burke, |Patterson, |
| | |Campos, Chiu, Gomez, |Steinorth, Waldron |
| | |Roger Hernández, | |
| | |Nazarian, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Appropriations |14-6 |Gonzalez, Bloom, |Bigelow, Patterson, |
| | |Bonilla, Bonta, |Gallagher, Jones, |
| | |Calderon, Daly, |Obernolte, Wagner |
| | |Eggman, Eduardo | |
| | |Garcia, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
SB 10
Page 2
| | |Holden, Quirk, | |
| | |Santiago, Weber, Wood | |
| | | | |
| | | | |
--------------------------------------------------------------------
SUMMARY: Requires the California Health Benefits Exchange (the
Exchange now called Covered California) to apply for a waiver
under Section 1332 of the Patient Protection and Affordable Care
Act (ACA) to allow persons otherwise not able to obtain coverage
by reason of immigration status to obtain coverage through the
Exchange.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Minor and absorbable administrative costs to Covered
California to apply for the waiver.
2)Significant Information Technology (IT) costs to Covered
California, potentially in the millions. Costs include
planning, development, and testing of functionality to allow
for designation of undocumented status, and facilitate
enrollment into "California qualified health plans"
(California Health Trust Fund).
3)Potentially significant, unknown ongoing costs to Covered
California associated with additional enrollment and
maintenance of IT systems. Covered California also notes
implementation would need to include revisions to their
marketing campaign, to explain potentially confusing
differences in subsidies for families of mixed immigration
status.
SB 10
Page 3
COMMENTS: The author states that this bill directs the state to
apply for a federal waiver to allow undocumented Californians to
buy health insurance with their own money through Covered
California. According to the author, this bill affirms
California's commitment to embrace and integrate our immigrant
community, to lead where the federal government has failed, and
to acknowledge the hard work and sacrifice of a community that
contributes billions of dollars to our gross domestic product.
If successful, this bill will allow 390,000 immigrants who earn
an income too high to qualify for Medi-Cal to purchase
healthcare through the Exchange under the ACA. This bill will
make California the first state in the nation to make this
petition to the federal government.
Under existing state and federal law, undocumented adults who
are otherwise income-qualified for Medi-Cal are not eligible for
full scope services, and are instead eligible for "limited
scope" Medi-Cal benefits. Limited scope services are long-term
care, pregnancy-related benefits, and emergency services.
Undocumented immigrants are also prohibited from purchasing
coverage on the Exchange under federal law, and are ineligible
for federal subsidies. California law requires health plans and
insurers to make the same health plans and policies available on
and off the Exchange, and currently, all Californians can enroll
off the Exchange; however, these products would not be
subsidized with advanced premium tax credit or cost sharing
reductions. The University of California, Berkeley, Center for
Labor Research and Education indicated that more than 2.7
million Californians are expected to remain uninsured under the
ACA in 2019.
Current California law also extended full-scope Medi-Cal
benefits to children. Specifically, SB 75 (Committee on Budget
and Fiscal Review), Chapter 18, Statutes of 2015, requires the
Department of Health Care Services to provide full-scope
Medi-Cal benefits to children, under age 19, who do not have
SB 10
Page 4
satisfactory immigration status or are unable to establish
satisfactory immigration status. Implementation began on May 16
and full-scope eligibility will be retroactive to May 1.
The federal ACA included a provision (Section 1332) that allows
certain ACA requirements to be waived and allows states to
pursue broad alternative approaches to expand coverage, or
targeted changes like the one proposed in this bill. Waivers
must meet several federal requirements related to affordability
and coverage and must not increase the federal deficit over 10
years. Federal guidance related to Section 1332 waivers was
released last year, and waivers can be effective as early as
January 1, 2017.
Covered California engaged stakeholders to discuss potential
Section 1332 waiver proposals and notes that a Section 1332
waiver would require considerable Covered California staff time
and resources. Covered California states that there was
significant public comment in support of expanding coverage to
additional populations such as undocumented Californians
specifically that all members of mixed immigration status
families would be able to apply for coverage directly through
Covered California. This proposal would simplify the family
health insurance shopping and enrollment experience. Covered
California also notes that there was not conclusive data
presented regarding the demand for Covered California enrollment
from undocumented Californians. Expert opinion indicated that
there could be an increase in overall enrollment in Covered
California due to mixed families being more likely to apply
through one-stop shopping and because of reduced fears related
to immigration status of undocumented family members. The
estimated potential enrollment presented to Covered California
during the stakeholder discussions was 50,000.
With respect to Covered California funding, and to generate
revenue to support its development, operations, and cash
SB 10
Page 5
management, Covered California assesses a charge on the
qualified health plans offered by insurance issuers (issuers).
These charges are referred to as plan assessments. These plan
assessments are paid by the issuers who sell insurance to
consumers from within the exchange.
This bill is supported by numerous health care, immigration,
labor, and other advocacy organizations.
There is no registered opposition on file.
Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN:
0003083