BILL ANALYSIS Ó SB 4 Page 1 SENATE THIRD READING SB 4 (Lara) As Amended September 1, 2015 Majority vote SENATE VOTE: 28-11 ------------------------------------------------------------------ |Committee |Votes|Ayes |Noes | | | | | | | | | | | | | | | | |----------------+-----+----------------------+--------------------| |Health |12-6 |Bonta, Bonilla, |Maienschein, | | | |Burke, Chiu, Gomez, |Chávez, Lackey, | | | |Gonzalez, |Patterson, | | | | |Steinorth, Waldron | | | | | | | | |Roger Hernández, | | | | |Nazarian, Rodriguez, | | | | |Santiago, Thurmond, | | | | |Wood | | | | | | | |----------------+-----+----------------------+--------------------| |Appropriations |12-5 |Gomez, Bloom, Bonta, |Bigelow, Chang, | | | |Calderon, Nazarian, |Gallagher, Jones, | | | |Eggman, Eduardo |Wagner | | | |Garcia, Holden, | | | | |Quirk, Rendon, Weber, | | | | |Wood | | SB 4 Page 2 | | | | | | | | | | ------------------------------------------------------------------ SUMMARY: Requires the Secretary of the California Health and Human Services Agency (CHHSA) to apply for a federal waiver in order to allow persons who are unable to obtain health insurance coverage through California's Health Benefit Exchange (Covered California) because of their immigration status, to do so. Requires, when 2015 Budget bill language making undocumented children under the age of 19 eligible for full scope Medi-Cal benefits is implemented, that individuals enrolled in restricted scope Medi-Cal at that time be transitioned to full scope Medi-Cal within 30 days. FISCAL EFFECT: According to the Assembly Appropriations Committee, minor, absorbable costs to CHHSA and costs in the range of $100,000 to Covered California (California Health Trust Fund) to pursue a narrow federal waiver; minor, absorbable ongoing administrative costs to Covered California (California Health Trust Fund) to designate California qualified health plans (QHPs); significant Information Technology costs to Covered California, potentially in the millions (California Health Trust Fund), potentially significant, unknown ongoing costs from the same fund; and, negligible increased costs associated with a 30-day timeline for transition of children to full-scope Medi-Cal. The 2015-16 Budget assumed transition by June 1, 2016. COMMENTS: According to the author, without access to affordable, quality health insurance, people are forced to rely on emergency care, which means they delay treatment until they are sicker and treatment is more expensive. The author states that 60% of Californians who have individual coverage have it through Covered California, and there is no reason why undocumented immigrants should not be able to purchase it SB 4 Page 3 through the Exchange as well. The author also notes that the Legislature and the Governor, through the enactment of the Budget Act of 2015 (SB 97 (Budget and Fiscal Review Committee), Chapter 11, Statutes of 2015) expanded Medi-Cal eligibility for children under the age of 19, regardless of immigration status, to ensure that no child in California who is income eligible will be denied access to health care coverage. These provisions are slated to go into effect some time on or after May 1, 2016. This bill will make certain that children currently eligible for limited scope Medi-Cal are quickly transitioned to full-scope Medi-Cal. The author concludes, we've made enormous strides to reduce California's uninsured population with the implementation of the Patient Protection and Affordable Care Act (ACA), but only when we include everyone can we have a truly healthy California. Covered California and the individual market. As an active purchaser, Covered California chooses which plans and products to offer and negotiates rates in order to offer the best value for consumers. In contrast, most other state exchanges and the federal health care exchange accept all products that health insurance companies wish to offer, at the rates they want to charge, provided that they meet basic standards and have passed regulatory review. 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 in which 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. Undocumented immigrants are prohibited from purchasing coverage in Covered California under federal law. Because Advanced Premium Tax Credits and cost-sharing subsidies are only available for individuals purchasing coverage in Covered SB 4 Page 4 California, undocumented individuals are also not eligible for these subsidies intended to make health insurance and the cost of care more affordable. This bill requires CHHSA to apply for a Section 1332 waiver in order to allow persons who cannot obtain coverage through Covered California because of their immigration status to obtain such coverage. 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. In order to be Medi-Cal eligible, an individual must be a state resident and generally must be low-income. Recent legal immigrants and undocumented immigrant adults who meet income and residency requirements are Medi-Cal eligible, but the scope of that coverage depends on the immigration status of the immigrant. Under existing state and federal law, undocumented immigrants 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. Medi-Cal also provides coverage for undocumented individuals needing breast and cervical cancer treatment, family planning services through Family Planning, Access, Care, and Treatment program, and through temporary presumptive eligibility programs. A January 2015 report from the University of California Berkeley SB 4 Page 5 Center for Labor Research and Education and the University of California Los Angeles Center for Health Policy Research estimated the ACA is expected to reduce California's uninsured rate by at least half by 2019, at which time the ACA will be fully implemented, as they estimate 6.5 million Californians would have remained uninsured by 2019 without the ACA. The report indicates that between 2.7 and 3.4 million Californians will remain uninsured by 2019. Overall, between 1.4 million and 1.5 million undocumented immigrants in California are projected to remain uninsured in 2019, comprising up to half of all Californians remaining uninsured. Health Access California supports this bill stating, some of the 350,000-400,000 Californians with incomes above the Medi-Cal income threshold who are unauthorized and uninsured can afford to pay for their own coverage. Health Access notes, since the cost of coverage varies by age and geographic region, the ability to afford coverage varies as well, but for a family that makes less than 250% FPL, there is coverage at a very modest price for the adults who are citizens or lawful residents and the children, regardless of immigration status. To give an example of affordable coverage for a family, Health Access explains that, if the kids are on Medi-Cal and the mother who is lawful is in Covered California with a subsidy, the family that lives on $3,000-$4,000 a month may be able to afford to pay the $200-$300 a month for health insurance for the undocumented father who is the primary earner. Health Access concludes those who are unauthorized and uninsured should have the same opportunity as the rest of us. The National Immigration Law Center (NILC) states, individuals and communities suffer when people are uninsured. NILC notes, the uninsured are more likely to be diagnosed with cancer at an advanced state, to die after a heart attack or accident, and to suffer poor outcomes from a stroke. NILC concludes, we are all better off when everyone has access to health insurance. The Western Center on Law and Poverty supports this bill, noting as SB 4 Page 6 California leads the way in implementing the ACA, providing comprehensive health coverage for undocumented children is just the humane thing to do. We the People Rising states in opposition to a previous version of this bill, that United States Veterans and their children, children in foster care, homeless families, and the unemployed should be the focus of legislation in Sacramento - not individuals residing unlawfully in California. Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0001710