BILL ANALYSIS
AB 56
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Date of Hearing: May 6, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 56 (Portantino) - As Amended: April 21, 2009
Policy Committee: Health Vote:13-6
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health plans and insurers to send a written
notice to specified women about the screening or diagnosis of
breast cancer according to clinical guidelines. Under current
law, mammography is a covered benefit for all health plans and
insurers. This bill clarifies provisions of current law
requirements regarding mammography screening.
FISCAL EFFECT
1)According to the California Health Benefits Review Program
(CHBRP), annual costs of $374,000 (50% GF) to Medi-Cal and
$75,000 (60% GF) CalPERS to account for mailings to eligible
women and related increased mammography that may result from
notifications required by this bill. According to CHBRP
estimates, 20,000 more women will receive mammography cancer
screening as a result of the notice required by this bill.
2)Annual increased premium costs across the private insurance
market of $2.4 million as a result of increased mammography
screening resulting from this bill.
COMMENTS
1)Rationale . This bill is sponsored by the American College of
Obstetricians and Gynecologists (ACOG) and requires increased
specificity with regard to health plan and insurer
notification of women eligible for breast cancer screening via
mammography. Under current law, both health plans and insurers
are mandated to provide mammography services. However, only
half of women receive the screening pursuant to national
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clinical guidelines. According to the author and sponsor,
women fail to access covered mammography services because they
are not aware of recommendations and individual risk factors.
This bill increases the notification requirements for women
and may result in an increase in breast cancer screening and
detection.
2)Breast Cancer in California . One in nine women in California
has a lifetime risk of being diagnosed with breast cancer. The
breast cancer death rate in California has dropped 20% over
the last two decades, but California women are more likely to
be diagnosed with breast cancer today. While the death rate
for breast cancer has dropped, the gains have not been shared
equally among all women. Women of color and low-income women
are less likely to be diagnosed at an early stage of cancer
and receive effective treatment. Therefore their survival
rates are lower than other groups of women. For example,
African-American women, although less likely to be diagnosed
with breast cancer, have one of the highest breast cancer
death rates.
3)Industry Cost Concerns . Opponents of this bill indicate
legislatively mandated health benefits increase costs and
limit insurer, employer, and individual choices with respect
to a variety of health benefits. Insurers indicate this bill
limits individual, employer, and employee choices with respect
to health care expenditures, without a related health benefit.
When considered together, mandates may also hinder the ability
of insurers and employers to offer a wide range of affordable
products to consumers with a variety of health care needs.
4)Related Legislation . There are more than two dozen current law
health mandates, established over the last two decades, to
provide coverage for specified services such as cancer
screenings and treatment. There are another handful of
mandates to offer coverage for a number of other health
services.
AB 2234 (Portantino) in 2008 required breast cancer screening
and treatment according to national guidelines. AB 2234 was
broader and increased public costs by $25 million and private
insurance costs by more than $250 million. AB 2234 was held on
the Suspense File of this committee.
5)Other Health Mandates in the Current Session . There are nine
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health mandates under legislative consideration this year,
including AB 56. Other proposed health mandates include:
i) AB 98 (De La Torre): maternity coverage
ii) AB 163 (Emmerson): amino acid elemental formula
coverage
iii) AB 214 (Chesbro): durable medical equipment coverage
iv) AB 244 (Beall): mental health parity
v) AB 259 (Skinner): access to nurse midwives
vi) AB 513 (De Leon): lactation consultant coverage
vii) SB 158 (Wiggins): HPV vaccine coverage
vii) SB 161 (Wright): chemotherapy treatment
a) Two other bills address minimum coverage or loosening of
current law mandates in the current session. These two
bills are:
i) AB 786 (Jones): standardization of individual market
products
ii) SB 92 (Aanestad): out-of-state carrier coverage
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081