BILL ANALYSIS Ó
SB 4
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SENATE THIRD READING
SB
4 (Lara)
As Amended September 1, 2015
Majority vote
SENATE VOTE: 28-11
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|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
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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
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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
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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
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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
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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