BILL ANALYSIS Ó
SB 923
Page 1
Date of Hearing: June 29, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 923
(Hernandez) - As Amended May 31, 2016
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|Policy |Health |Vote:|17 - 0 |
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
This bill prohibits health care service plans and health
insurance carriers from changing cost-sharing requirements
during a plan or policy year in the individual and small-group
markets.
FISCAL EFFECT:
Costs to Department of Managed Health Care and California
Department of Insurance are expected to be minor and absorbable,
SB 923
Page 2
if any (Managed Care Fund/Insurance Fund).
COMMENTS:
1)Purpose. The author explains one of the many individual market
reforms California enacted while implementing the ACA was a
provision that prohibited plans and insurers from altering
premiums during the plan year. This essential patient
protection, while meaningful on its own, does not currently
apply to cost-sharing requirements such as deductibles,
co-payments, and coinsurance. This bill is sponsored by
Health Access, is supported by a number of health, legal, and
consumer advocacy groups, and has no opposition.
2)Background. The health insurance market is comprised of
large-group, small-group, and individual segments.
Large-group purchasers are generally large and sophisticated
entities, such as employers, government agencies, and labor
unions. Most provisions of the federal Affordable Care Act
reformed the individual and small-group markets, whose
purchasers were less able to negotiate reasonable prices and
protections. This bill expands on existing protections in
the ACA and California state law, which include limits on
cost-sharing, guaranteed issuance of coverage regardless of
preexisting conditions, and standardized, easily comparable
benefit structure for health plans and policies.
3)Prior Legislation.
a) SB 639 (Hernandez, Chapter 316, Statutes of 2013) placed
in California law, provisions of the ACA relating to
cost-sharing limits, coverage levels, and other
requirements.
SB 923
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b) ABX1 2 (Pan, Chapter 1, Statutes of 2013) and SBX1 2
(Hernandez, Chapter 2, Statutes of 2013) establish health
insurance market reforms contained in the ACA specific to
individual purchasers.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081