BILL ANALYSIS
AB 98
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Date of Hearing: April 22, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 98 (De La Torre) - As Amended: April 13, 2009
Policy Committee: Health Vote:13-4
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill requires policies in the individual and group health
insurance markets to provide coverage for maternity services,
which include:
1)prenatal care
2)ambulatory care
3)care for pregnancy complications
4)neonatal care
5)inpatient hospital maternity care
6)postpartum care.
FISCAL EFFECT
1)No direct state fiscal impact for publicly supported health
coverage provided through Medi-Cal, CalPERS, or Healthy
Families according to the California Health Benefits Review
Program (CHBRP).
This bill creates a mandate on insurers and not health plans, as
maternity benefits are already mandated for health plans
regulated by the Department of Managed Health Care (DMHC). In
addition, most enrollees in small- and large-employer group
coverage already have maternity benefits. Therefore, the
mandate established by this bill applies to a relatively small
part of the insurance market in California, specified
individual policies regulated by the California Department of
Insurance (CDI). CDI indicates some staffing costs are created
to account for increased review of insurer filings following
enactment of this bill.
2) Additional costs in the private
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health insurance market associated with individual market
premium increases. This bill's requirement with respect to
maternity coverage would increase these premiums by $90
million. The figure generally reflects a reduction in
out-of-pocket costs for women in the individual market who
would otherwise pay for a variety of services not covered by
insurance in the absence of this mandate. This bill may have a
significant impact on specific products in the individual
insurance market. For example, one of California's largest
insurers indicates premiums for some young and healthy
enrollees will double, from $67 per month to $138 per month.
In addition, CHBRP analysis indicates a loss of coverage due to
premium increases in the individual market of 7,600. Therefore
this bill may increase the number of uninsured among younger
and healthier enrollees more sensitive to premium increases.
3)AB 1996 (Thomson), Chapter 795, Statutes of 2002, created
CHBRP which is required to publish analysis with relevant data
on the public health, medical, and economic impact of proposed
health plan and health insurance benefit mandate legislation.
COMMENTS
1)Purpose . This bill is sponsored by the California Commission
on the Status of Women to address a coverage inequity with
regard to maternity care. Health plans regulated by DMHC are
required by state law and most employers with group health
products regulated by CDI are required under federal
anti-discrimination laws to cover maternity services. Health
insurers in the individual market do not have a parallel
requirement. As a result, several products in the individual
market fail to provide a variety of maternity-related
coverage. This bill establishes a requirement in this market.
Providing equity with respect to maternity coverage provides
women and families in the individual health market greater
protection financially as well as better health outcomes for
new mothers and their children.
2)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
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services.
AB 1962 (De La Torre) in 2008 was similar to this bill. AB 1962
was vetoed due to affordability concerns with regard to health
coverage and the premium pressures created by this and other
health mandates.
3)Other Health Mandates in the Current Session . There are 11
health mandates under legislative consideration this year,
including AB 98. Other proposed health mandates include:
a) AB 56 (Portantino): mammography notification
b) AB 163 (Emmerson): elemental formula coverage
c) AB 214 (Chesbro): durable medical equipment coverage
d) AB 244 (Beall): mental health parity
e) AB 259 (Skinner): access to nurse midwives
f) AB 513 (De Leon): lactation consultant coverage
g) AB 786 (Jones): standardization of individual market
products
h) SB 92 (Aanestad): out-of-state carrier coverage
i) SB 158 (Wiggins): HPV vaccine coverage
j) SB 161 (Wright): chemotherapy treatment
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081