BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     SB 923  


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          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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          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  


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          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. 









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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