BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 10|
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UNFINISHED BUSINESS
Bill No: SB 10
Author: Lara (D), et al.
Amended: 5/27/16
Vote: 27 - Urgency
PRIOR SENATE VOTES NOT RELEVANT
ASSEMBLY FLOOR: 55-20, 5/31/16 - See last page for vote
SUBJECT: Health care coverage: immigration status
SOURCE: Health Access California
DIGEST: This bill requires Covered California to apply to the
United States Department of Health and Human Services for a
Section 1332 waiver to allow persons who are not otherwise able
to obtain coverage through Covered California by reason of
immigration status to obtain coverage from Covered California by
waiving the requirement that Covered California offer only
qualified health plans.
Assembly Amendments delete the Senate-approved version of this
bill.
ANALYSIS:
Existing federal law:
1)Requires, under the Patient Protection and Affordable Care Act
(ACA, Public Law 111-148), as amended by the Health Care
Education and Reconciliation Act of 2010 (Public Law 111-152),
each state, by January 1, 2014, to establish an American
Health Benefit Exchange that makes qualified health plans
(QHPs) available to qualified individuals and qualified
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employers. Requires, if a state does not establish an
Exchange, the federal government to administer the Exchange.
Establishes requirements for the Exchange and for QHPs
participating in the Exchange, and defines who is eligible to
purchase coverage in the Exchange.
2)Limits enrollment in the Exchanges to citizen or nationals of
the United States, or an alien lawfully present in the United
States.
3)Allows, under the ACA and effective January 1, 2014, eligible
individual taxpayers, whose household income is between 100
and 400 percent of the Federal Poverty Level (FPL), an
advanceable and refundable premium tax credit (APTC) based on
the individual's income for coverage under a QHP offered in
the Exchange. Requires a reduction in cost-sharing for
individuals with incomes below 250 percent of the FPL, and a
lower maximum limit on out-of-pocket expenses for individuals
whose incomes are between 100 and 400 percent of the FPL.
Legal immigrants with household incomes less than 100 percent
of the FPL who are ineligible for Medicaid because of their
immigration status are also eligible for the APTC and the
cost-sharing reductions.
4)Authorizes, under Section 1332 of the ACA, waivers for state
innovation under which states can seek federal approval to
waive major provisions of the ACA, including the requirement
for Exchanges, QHPs, premium tax credits and cost-sharing
reductions, the individual mandate and the employer
responsibility requirement, provided federal requirements are
met for comprehensive benefits, affordability, and comparable
coverage are met and the state proposal does not increase the
federal deficit.
Existing state law establishes the California Health Benefit
Exchange (known as Covered California) in state government, and
specifies its duties and authority. Requires Covered California
to be governed by a board that includes the Secretary of the
California Health and Human Services Agency (Agency) and four
members with specified expertise who are appointed by the
Governor and the Legislature.
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This bill:
1)Requires Covered California to apply to the United States
Department of Health and Human Services for a Section 1332
waiver to allow persons not otherwise able to obtain coverage
through Covered California by reason of immigration status to
obtain coverage from Covered California by waiving the
requirement that Covered California offer only QHPs.
2)Requires that the waiver of the requirement that Covered
California offer only QHPs be limited to requiring Covered
California to offer "California QHPs," which are solely for
the purpose of offering coverage to persons not able to obtain
coverage by reason of immigration status. Prohibits this bill
from being construed to authorize Covered California to offer
any other non-QHP.
3)Requires Covered California to require health plan that offer
a QHP in the individual market through Covered California to
concurrently offer a California QHP that meets all of the
following criteria:
a) Is subject to the requirements of Covered California,
including all of those requirements applicable to QHPs.
b) Is identical to the corresponding QHP, except for the
eligibility requirements set forth below.
4)Requires persons eligible to purchase California QHP to pay
the cost of coverage, and prohibits these persons from:
a) Being eligible to receive federal APTC, federal
cost-sharing reduction, or any other federal assistance for
the payment of premiums or cost sharing for a California
QHP.
b) Otherwise being eligible for enrollment in a QHP offered
through Covered California by reason of immigration status.
5)Requires an applicant for coverage under this bill to be
required to provide only the information strictly necessary to
authenticate identity and determine eligibility under this
bill.
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6)Prohibits any person who receives information provided by an
applicant under this bill, whether directly or by another
person at the request of the applicant, or receives
information from any agency, to use the information only for
the purposes of, and to the extent necessary for, ensuring the
efficient operation of Covered California, including verifying
the eligibility of an individual to enroll through Covered
California. Prohibits that information from being disclosed to
any other person except as provided in this bill.
7)Makes paragraphs 3) through 6) above operative on January 1,
2018, for coverage effective for California QHPs beginning
January 1, 2019, contingent upon federal approval of the
Section 1332 waiver.
Comments
1)Author's statement. 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 Covered California under the
ACA. This bill will make California the first state in the
nation to make this petition to the federal government.
Additionally, the author states that prohibiting immigrants
from buying insurance from the Covered California with their
own money is irrational. Furthermore, the author contends that
this is a discriminatory policy that does not reflect our
California values. Through a waiver request to the federal
government, the author states that we can fix that.
2)Covered California and the individual market. Undocumented
immigrants are prohibited from purchasing coverage in Covered
California under federal law. Because APTCs and cost-sharing
subsidies are only available for individuals purchasing
coverage in Covered California, undocumented individuals are
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also not eligible for these subsidies intended to make health
insurance and the cost of care more affordable. In the
individual market outside Covered California, plans and
insurers are required to fairly and affirmatively offer,
market and sell to all individuals and dependents in each
service area the plan or insurer provides services. Plans and
insurers are required to limit enrollment in individual
products to open enrollment periods and special enrollment
periods.
3)Section 1332 Waivers. Section 1332 of the ACA permits states
to apply to the federal government for a waiver of major
provisions of the ACA beginning in 2017. Known as "innovation
waivers," the provisions of the ACA that can be waived under
Section 1332 include any or all parts of the provisions
relating to QHPs (including the essential health benefits
package requirement), the Exchanges, premium tax credits and
cost-sharing reductions, the minimum coverage requirement
(individual mandate), and the employer responsibility
requirements.
If a state is granted a Section 1332 waiver, the state can fund
its reforms through the aggregate amount of federal funding
that otherwise would have been paid out within the state for
premium tax credits, cost-sharing reduction payments, and
small business tax credits. However, to qualify for an
innovation waiver, the state must establish that its reform
plan would provide coverage that:
a) Will provide coverage that is least as comprehensive as
ACA coverage;
b) Will provide coverage and cost sharing protections
against excessive out-of-pocket spending that are at least
as affordable as the as ACA coverage;
c) Will provide coverage to at least a comparable number of
its residents as the ACA would provide; and,
d) Will not increase the federal deficit.
4)Assembly amendments. The Senate-approved provisions of this
bill were deleted in the Assembly. However, language
substantially similar to the current contents of this bill
were heard by the Senate in SB 4 (Lara).
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FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
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 QHPs " (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.
SUPPORT: (Verified5/31/16)
Health Access California (source)
Advancement Project
Alameda Health Consortium
Alliance for Boys and Men of Color
American Academy of Pediatrics, California
American Federation of State, County and Municipal Employees,
AFL-CIO
Asian Americans Advancing Justice
Asian Law Alliance
ASPIRE
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California Academy of Family Physicians
California Alliance for Retired Americans
California Asian Pacific Islander Budget Partnership
California Black Health Network
California Chapter of the American College of Emergency Physicians
California Coverage & Health Initiatives
California Family Resources Association
California Immigrant Policy Center
California Immigrant Policy Collaborative
California Labor Federation
California Latinas for Reproductive Justice
California Lesbian, Gay, Bisexual, and Transgender Health and Human
Services
Network
California National Organization for Women
California Pan Ethnic Health Network
California Partnership
California Primary Care Association
California Rural Legal Assistance Foundation
California School Employees Association
California Teachers Association
Campaign for a Healthy California
Children Now
Children's Defense Fund California
Children's Health Coverage Coalition
Children's Partnership
Coalition for Humane Immigrant Rights of Los Angeles
Coalition of California Welfare Rights Organizations, Inc.
Coalition of Orange County Community Health Centers
Community Clinic Association of Los Angeles County
Community Clinic Consortium
Community Health Councils, Inc.
Community Health Initiative of Orange County
Consumer Watchdog
Fathers & Families of San Joaquin
Having Our Say
Korean Community Center of the East Bay
L.A. Care Health Plan
Latino Health Access
Long Beach Immigrant Rights Coalition
Los Angeles LGBT Center
Maternal and Child Health Access
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National Association of Social Workers, California Chapter
National Health Law Program
National Immigration Law Center
NICOS Chinese Health Coalition
Older Women's League
People Demanding Action
Physicians for a National Health Program
PICO California
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Pre-Health Dreamers
Providence Health & Services
Public Law Center
Reach Out
San Francisco Community Clinic Consortium
Senior and Disability Action
Service Employees International Union of California
Single Payer Now
South Asian Network
Southeast Asian Resource Action Center
Street Level Health Project
United Steel Workers Local 675
United Way Fresno and Madera Counties
United Way of Stanislaus County
United Way of the Bay Area
United Ways of California
Visión y Compromiso
Western Center on Law and Poverty
Young Invincibles
OPPOSITION: (Verified5/31/16)
None received
ARGUMENTS IN SUPPORT: This bill is supported by numerous
health care, immigration, labor, and other advocacy
organizations. Western Center on Law & Poverty (WCLP) writes
that California needs to adopt inclusionary health coverage
policies because immigrants without satisfactory immigration
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status were left out of federal health reform. WCLP contends
that this bill would take another important step in allowing the
whole family regardless of status to obtain coverage together on
Covered California. WCLP notes that undocumented immigrants
contribute substantially to the California economy and should
benefit from our public program. Health Access California
(Health Access) contends that California's health system, and
Californians in general, are healthier and stronger when every
Californian has the opportunity to have affordable,
comprehensive health coverage. Existing law allows undocumented
individuals to buy coverage as individuals in the market off the
Exchange. However, if an undocumented individual or a family
with an undocumented family member shows up at Covered
California, the undocumented individual is barred from
purchasing covered through Covered California and must be turned
away. Health Access states that while affordability will
continue to be a barrier, this bill would provide a practical
benefit to many families with mixed immigration status, so that
Covered California could assist the entire family in signing up
for coverage, even if some will be subsidized and others not.
Health Access contends that over 70% of undocumented
Californians are in families with legal residents.
ASSEMBLY FLOOR: 55-20, 5/31/16
AYES: Alejo, Arambula, Atkins, Baker, Bloom, Bonilla, Bonta,
Brown, Burke, Calderon, Campos, Chau, Chiu, Chu, Cooley,
Cooper, Dababneh, Daly, Dodd, Eggman, Frazier, Cristina
Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,
Gordon, Gray, Hadley, Roger Hernández, Holden, Irwin,
Jones-Sawyer, Levine, Linder, Lopez, Low, McCarty, Medina,
Mullin, Nazarian, O'Donnell, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Mark Stone, Thurmond, Ting, Weber, Williams,
Wood, Rendon
NOES: Travis Allen, Bigelow, Brough, Chang, Dahle, Beth Gaines,
Gallagher, Grove, Harper, Jones, Lackey, Mathis, Mayes,
Melendez, Obernolte, Olsen, Patterson, Steinorth, Wagner, Wilk
NO VOTE RECORDED: Achadjian, Chávez, Kim, Maienschein, Waldron
Prepared by:Scott Bain / HEALTH /
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6/1/16 18:41:43
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