BILL ANALYSIS
SB 158
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Date of Hearing: July 1, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
SB 158 (Wiggins) - As Amended: June 17, 2009
Policy Committee: Health Vote:13-5
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill requires health plan and health insurance coverage
that includes treatment for cervical cancer to also provide
coverage for vaccination against the human papillomavirus (HPV),
the virus that causes most cancers of the cervix.
FISCAL EFFECT
1)According to the California Health Benefits Review Program
(CHBRP), no direct GF costs for Medi-Cal, the Healthy Families
Program, or CalPERS to comply with the coverage requirements
of this bill. These health coverage programs already comply
with national guidelines for vaccination, including the
mandate established by this bill.
2) Additional costs of $1.4 million in
premiums paid in the private health insurance market
associated with individual and group coverage. About 25% of
this increase is offset by reduced out-of-pocket costs paid by
families for HPV vaccination prior to the mandate. Under
current law, health plans regulated by the Department of
Managed Health Care (DMHC) provide coverage for the mandate
established by this bill in 100% of policies. For health
insurers regulated by the California Department of Insurance
(CDI), coverage for this health mandate is between 88% and
100%, depending on whether a policy is in the individual,
small group, or large group insurance market. Under private
insurance coverage, the cost of the three-dose HPV vaccine is
$468.
COMMENTS
1)Rationale . This bill is co-sponsored by the California
Chapter of the American College of Obstetricians and
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Gynecologists (ACOG) and the Community Health Clinic Ole in
Napa County. This bill requires coverage for HPV vaccination
when treatment for cervical cancer is provided by a health
plan or insurer. HPV vaccination may protect against cervical
cancer, which is most often caused by HPV. HPV is extremely
common, with more than 80% of sexually active women becoming
infected at some point in their lifetime. If vaccinations are
effective, fewer women will develop cervical cancer each year.
In California, approximately 1,400 women are diagnosed with
and 400 women die of cervical cancer each year. Cervical
cancer may be dormant for years and undetected. Annual exams,
including cancer screening tests, have reduced cervical cancer
rates dramatically in recent decades
2)Background . Most vaccination guidelines available at this
time, including the American Academy of Pediatrics, the
American Academy of Family Medicine, and the American Cancer
Society indicate girls ages 11 and 12 should be vaccinated
against HPV. This young age is recommended prior to sexual
activity when HPV exposure may occur in later adolescence.
Vaccination when girls are older is less effective, as many
have then been exposed to the virus, which is found more
frequently in young women just a few years older.
3)Possible Safety Concerns . Gardasil, manufactured by Merck, is
currently the only HPV vaccine approved by the Federal Drug
Administration (FDA) and has been available since June 2006.
Recently the FDA strengthened warnings about patient fainting
incidents following vaccination. Warnings to providers have
been strengthened and moved to a more prominent place on
vaccine packaging. Other, more serious adverse vaccine events
have also been reported, but the FDA continues to confirm
Gardasil's safety and efficacy.
4)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. Opponents indicate health
mandates can hinder compliance with evidence-based medical
standards that reflect new medical technology or other
advances in knowledge. 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.
5)Related Legislation . There are more than two dozen current law
health mandates, established over the last two decades, to
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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 1429 (Evans) in 2007 and AB 16 (Evans) in 2008 were both
similar to this bill and vetoed due to concerns about the
costs of establishing additional health mandates.
6)Other Health Mandates in the Current Session . There are nine
health mandates under legislative consideration this year,
including SB 158. Other proposed health mandates include:
a) AB 56 (Portantino): mammography notification- pending in
the Senate
b) AB 98 (De La Torre): maternity coverage- pending in the
Senate
c) AB 163 (Emmerson): amino acid-based elemental formulas-
held on the Suspense File of this Committee
d) AB 214 (Chesbro): durable medical equipment coverage-
held on the Suspense File of this Committee
e) AB 244 (Beall): mental health parity- pending in the
Senate
f) AB 259 (Skinner): access to nurse midwives- pending in
the Assembly Health Committee
g) AB 513 (De Leon): lactation consultant coverage- pending
in the Senate
h) SB 161 (Wright): chemotherapy treatment- pending in the
Assembly Health Committee
Two other bills address specification of current law mandates
with respect to minimum coverage or loosening of current law
mandates. These two bills are:
a) AB 786 (Jones): standardization of individual market
products- pending in the Senate
b) SB 92 (Aanestad): out-of-state carrier coverage- failed
passage in the Senate Health Committee.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081