BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 158|
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UNFINISHED BUSINESS
Bill No: SB 158
Author: Wiggins (D), et al
Amended: 8/31/09
Vote: 21
SENATE HEALTH COMMITTEE : 8-3, 4/22/09
AYES: Alquist, Cedillo, DeSaulnier, Leno, Maldonado,
Negrete McLeod, Pavley, Wolk
NOES: Strickland, Aanestad, Cox
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SENATE FLOOR : 23-13, 5/11/09
AYES: Alquist, Corbett, Correa, DeSaulnier, Ducheny,
Florez, Hancock, Kehoe, Leno, Liu, Lowenthal, Maldonado,
Negrete McLeod, Oropeza, Padilla, Pavley, Romero,
Steinberg, Wiggins, Wolk, Wright, Wyland, Yee
NOES: Aanestad, Ashburn, Benoit, Cogdill, Cox, Denham,
Dutton, Harman, Hollingsworth, Huff, Runner, Strickland,
Walters
NO VOTE RECORDED: Calderon, Cedillo, Simitian
ASSEMBLY FLOOR : 49-24, 09/02/09 - See last page for vote
SUBJECT : Health care coverage: human papillomavirus
vaccination
SOURCE : American College of Obstetricians &
Gynecologists,
District IX
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DIGEST : This bill requires health care service plan
contracts and health insurance policies that provide
coverage for cervical cancer treatment or surgery to also
provide coverage for a human papillomavirus (HPV) vaccine
beginning on, or after January 1, 2010.
Assembly Amendments : (1) provided exemptions to the
provisions of the bill, (2) added specified screening
tests, and (3) added coauthors.
ANALYSIS : Existing law:
1.Provides for the regulation of health plans by the
Department of Managed Health Care and health insurers by
the California Department of Insurance.
2.Requires health plans to cover all medically necessary
basic health care services, as defined, including
"preventive health care services," defined in regulations
to include childhood immunizations recommended by the
American Academy of Pediatrics and adult immunizations
recommended by the U.S. Public Health Service.
3.Requires health plans and health insurers that offer
coverage on a group basis to cover comprehensive
preventive care for children ages 16 or younger under the
terms and conditions agreed upon by the group and the
health insurer or health plan.
4.Requires health plans and health insurers that offer
coverage on a group basis to offer, rather than provide,
comprehensive preventive care for children ages 17 and
18, under terms and conditions agreed upon by the group
and the health insurer or health plan.
5.Defines comprehensive preventive care to include
immunizations recommended by the Centers for Disease
Control and Prevention (CDC) in their Recommended
Childhood Immunization Schedule.
6.Requires individual and group health plan contracts and
health insurance policies that include coverage for
treatment or surgery of cervical cancer to also include
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coverage of annual cervical cancer screening tests, upon
referral by the patient's physician and surgeon, a nurse
practitioner, or certified nurse midwife who is providing
care to the patient and operating within the scope of
practice otherwise permitted for the licensee.
This bill requires every individual or group health care
service plan contract, except for a specialized health care
service plan contract, that is issued, amended, or renewed,
on or after January 1, 2010, and that includes coverage for
treatment or surgery of cervical cancer shall also be
deemed to provide coverage for an annual cervical cancer
screening test and a human papillomavirus vaccination upon
the referral of the patient's physician and surgeon, a
nurse practitioner, a physician assistant, or certified
nurse midwife, providing care to the patient and operating
within the scope of practice otherwise permitted for the
licensee.
The coverage for an annual cervical cancer screening test
provided shall include the conventional Pap test, a human
papillomavirus screening test that is approved by the
federal Food and Drug Administration, and the option of any
cervical cancer screening test approved by the federal Food
and Drug Administration, upon the referral of the patient's
health care provider.
This bill further provides that every individual or group
policy of health insurance that is issued, amended, or
renewed on or after January 1, 2010, and that includes
coverage for treatment or surgery of cervical cancer shall
also be deemed to provide coverage, upon the referral of a
patient's physician and surgeon, a nurse practitioner, a
physician assistant, or a certified nurse midwife,
providing care to the patient and operating within the
scope of practice otherwise permitted for the licensee, for
an annual cervical cancer screening test and a human
papillomavirus vaccination. The coverage for an annual
cervical cancer screening test provided pursuant to this
section shall include the conventional Pap test, a human
papillomavirus screening test that is approved by the
federal Food and Drug Administration, and the option of any
cervical cancer screening test approved by the federal Food
and Drug Administration, upon the referral of the patient's
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health care provider.
This bill provides that this bill does not apply to
specialized health insurance, Medicare supplement,
short-term limited duration health insurance,
CHAMPUS-supplement, TRI-CARE supplement, or to hospital
indemnity, accident-only, and specified disease insurance.
Background
According to the National Cancer Institute, there are more
than 100 types of HPVs, of which 30 can be transmitted
sexually. Most HPV infections occur without any symptoms
and go away without treatment. Both "high-risk" and
"low-risk" HPVs can cause the growth of abnormal cells, but
generally, only high-risk HPVs lead to cancer, including
cervical, anal, and penile cancer. Of the women who
develop abnormal cervical cell changes with high-risk HPVs,
only a small percentage develop cervical cancer if the
abnormal cells are not removed. Approximately 90 percent
of new HPV infections clear within two years.
According to the CDC's Advisory Committee on Immunization
Practices (ACIP), an estimated 6.2 million new HPV
infections occur every year among persons aged 14 to 44
years in the U.S. Of these, 74 percent occur among those
aged 15 to 24 years. Estimates suggest that over 80
percent of sexually active women will have acquired genital
HPV by age 50. A 2007 study published in the Journal of
the American Medical Association found that the prevalence
of HPV infection in the U.S. was highest among 20 to 24
year olds (45 percent). For females 14 to 24 years, the
overall HPV prevalence was estimated at 34 percent.
Using population estimates, the Department of Public Health
estimates that there may be approximately 900,000
14-to-24-year-old California females with an HPV infection.
Approximately 372,000 California females ages 14 to 59
have a vaccine-preventable HPV infection.
ACIP also notes that the prevention and treatment of
anogenital warts and cervical HPV-related disease imposes
an estimated burden of $4 billion or more (2004 dollars) in
direct costs in the U.S. each year. Of this total,
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approximately $200 million is attributable to the
management of genital warts; approximately $300 to $400
million to invasive cervical cancer; and the remainder to
routine cervical cancer screening, the follow up of
abnormal Pap tests, and pre-invasive cervical cancer. The
estimated economic burden associated with HPV would be more
substantial if the cost of other HPV-related diseases were
included.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 9/3/09)
American College of Obstetricians & Gynecologists, District
IX (source)
American Cancer Society
California Academy of Physicians Assistants
California Commission on the Status of Women
California Communities United Institute
California Medical Association
Medical Oncology Association of Southern California
Planned Parenthood Affiliates of California
Planned Parenthood Shasta-Diablo
OPPOSITION : (Verified 9/3/09)
Anthem Blue Cross
Association of California Life and Health Insurance
Companies
California Association of Health Plans
California Association of Health Underwriters
California Chamber of Commerce
ARGUMENTS IN SUPPORT : The American College of
Obstetricians and Gynecologists, District IX, writes that
this vaccine will prevent hundreds of cervical cancer
deaths annually in California and prevent tens of thousands
of cases of abnormal cervical cancer cells, precancerous
conditions and cervical cancer. They assert that
prevention of the HPV infection and the conditions caused
by it should translate into an enormous cost savings to
health plans, insurers, and the state. The Medical
Oncology Association of Southern California states that
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mandating coverage of this vaccine will help remove
barriers to this important tool in cancer prevention. The
California Medical Association writes that maximum
immunization coverage in all populations is essential if we
want to keep preventable disease levels to a minimum.
Planned Parenthood Affiliates of California states that
this bill is a further step in comprehensive reproductive
health care and preventative medicine.
ARGUMENTS IN OPPOSITION : The Association of California
Life and Health Insurance Companies generally opposes all
benefit mandates because, while they sympathize with the
intent to meet a need, mandates increase the already high
costs of care for everyone and eliminate flexibility an
employer would otherwise have to pick benefits that best
address the needs of his or her employees in the future.
The California Association of Health Plans writes of
similar concerns, and adds that mandates in some cases can
lead to a reduction of coverage, as individuals and
employers drop their insurance due to premium impacts.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Block, Blumenfield,
Brownley, Caballero, Charles Calderon, Carter, Chesbro,
Coto, Davis, De La Torre, De Leon, Eng, Evans, Feuer,
Fletcher, Fong, Fuentes, Furutani, Galgiani, Hayashi,
Hernandez, Hill, Huber, Huffman, Jones, Krekorian, Lieu,
Bonnie Lowenthal, Ma, Mendoza, Monning, Nava, John A.
Perez, V. Manuel Perez, Portantino, Ruskin, Salas,
Saldana, Skinner, Solorio, Swanson, Torlakson, Torres,
Torrico, Yamada, Bass
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Blakeslee, Conway, Cook, DeVore, Duvall, Fuller, Gaines,
Garrick, Gilmore, Hagman, Harkey, Jeffries, Knight,
Miller, Niello, Nielsen, Silva, Smyth, Audra Strickland,
Villines
NO VOTE RECORDED: Buchanan, Emmerson, Hall, Logue,
Nestande, Tran
CTW:RJG:nl 9/3/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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