BILL ANALYSIS
SB 810
Page A
Date of Hearing: June 29, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 810 (Leno) - As Amended: January 13, 2010
SENATE VOTE : 22-14
SUBJECT : Single-payer health care coverage.
SUMMARY : Creates the California Healthcare System (CHS), a
single payer health care system, administered by the California
Healthcare Agency (CHA), to provide health insurance coverage to
all California residents. States that CHS would become
operative when the Secretary of Health and Human Services
determines the Healthcare Fund (Fund) has sufficient revenues to
implement this bill. Specifically, this bill :
1)Establishes CHS in state government, to be administered by the
CHA, an independent agency under the control of the Healthcare
Commissioner (Commissioner).
2)Prohibits any health care service plan or health insurance
policy, except for CHS, from being sold in California for
services provided by CHS.
Governance
3)Provides for a Commissioner, appointed by the Governor and
confirmed by the Senate, to be the chief officer of CHS and to
administer all aspects of the CHA.
4)Gives the Commissioner broad powers to establish CHS budget,
goals, standards, and priorities; set rates; and, perform
other duties as specified.
5)Establishes conflict-of-interest rules for the Commissioner.
6)Requires the Commissioner to oversee the establishment of:
a) The Healthcare Policy Board (Board), to set system goals
and priorities, determine the scope of services provided,
and determine when a change in premium structure is needed;
b) The Office of Patient Advocacy, headed by a patient
advocate;
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c) The Office of Health Planning, to plan for the short-
and long-term health needs of California;
d) The Office of Health Care Quality, to support the
delivery of high quality care and promote provider and
patient satisfaction;
e) The Fund within the State Treasury, to be administered
by a director appointed by the Commissioner;
f) The Public Advisory Committee, to advise the Board on
all matters of health insurance system policy;
g) The Payments Board, to establish and supervise a uniform
payments system and compensation plan for providers and
managers; and,
h) Partnerships for Health, to improve health through
community health initiatives, support the development of
innovative means to improve care quality, promote
efficient, coordinated care delivery, and educate the
public, as specified.
7)Directs the Commissioner to carry out numerous duties,
including establishing the CHS budget; set goals, standards,
and priorities for the system; set rates, fees, and prices;
establish a CHS enrollment system, systems for electronic
referral, medical records, claims, and reimbursement;
establish a prescription drug and durable medical equipment
formulary, and health planning regions; determine the
appropriate levels for a reserve fund for the system; appoint
specified officers and directors within the system; implement
specified cost control measures; oversee measures to ensure
quality of care; and, seek to secure a repeal or waiver of any
federal law provisions that would preempt any part of the
bill.
8)Establishes in the Office of the Attorney General an Office of
the Inspector General for CHS with broad powers to
investigate, audit, and review the financial and business
records of individuals and entities that provide services or
products to the system and are reimbursed by the system.
9)States that the operative date of this bill, except for
provisions related to the California Healthcare Premium
Commission (CHPC), shall be the date that the Secretary of
Health and Human Services notifies the Legislature that he or
she has determined that the Fund will have sufficient revenues
to fund the costs of implementing this bill. Requires CHS to
be operative within two years of the operative date of this
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bill. Prohibits any state entity from incurring any
transition or planning costs prior to the operative date of
this bill.
10) States that the activities of the CHPC are not subject to
9) above, and that provisions in this bill related to CHPC
become operative on January 1, 2011.
11) Requires the Commissioner to:
a) Assess health plans and insurers for care provided by
CHS if private coverage extends into the CHS' operational
time;
b) Implement a means to assist persons displaced from
employment as a result of the CHS;
c) Appoint a transition advisory group whose duties include
recommending how to integrate health care delivery services
and responsibilities of several state departments into CHS;
d) Establish up to 10 CHS regions composed of contiguous
counties grouped according to utilization patterns, health
care resources, health needs, geography, and population;
and,
e) Appoint a regional planning director for each region to
administer health insurance regions with duties as
specified.
12) Requires regional medical officers to administer all
aspects of the regional office of health care quality with
duties as specified.
13) Requires each region to have a regional health planning
board consisting of 13 members appointed by the regional
planning director in order to advise and make recommendations
to the regional planning director on all aspects of regional
health policy.
BUDGETING AND FINANCING
14)Establishes the Fund within the State Treasury, administered
by a director that is appointed by the Commissioner, into
which funds would be deposited to support CHS costs. Requires
all claims for health care services rendered pursuant to the
system to be submitted to the Fund via an electronic claims
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and payment system.
15)Requires the Fund director to establish a system account to
provide for all annual expenditures on health care, and a
reserve account to maintain a reserve sufficient to provide
for the payment for all losses and claims for which the system
may be liable.
16)Requires the Fund director to immediately notify the
Commissioner when trends indicate that expenditures for the
system may exceed revenues and to immediately notify the
Legislature and the public regarding the possible need for
cost control measures. Specifies the types of cost control
measures the Commissioner could implement, including changes
in the system of health facility administration that improve
efficiency, postponement of introduction of new benefits or
benefit improvements, imposition of co-payments and
deductibles under specified circumstances, imposition of an
eligibility waiting period if the commissioner determines that
people are immigrating to the state for the purpose of
obtaining health care through the system, and others as
specified.
17)Permits specified cost control measures may be followed at
the regional level, if the Commissioner or regional planning
director determines that regional revenue and expenditure
trends indicate a need for regional cost containment.
18)Requires, if the Budget Act has not been enacted by June 30th
of any year, all moneys in the reserve account of the Fund to
be used to implement the bill's provisions until funds became
available through the Budget Act. Requires the State
Controller to make one or more General Fund loans to the fund
for the purpose of making payments for health care goods and
services, if the reserve funds are exhausted.
19)Requires the Commissioner to establish a budget for all
expenditures, specifying a limit on total annual state
expenditures and establish regional allocations to cover a
three-year period. Requires the Commissioner to limit the
growth of spending on a statewide and regional basis with
reference to average growth in state domestic product across
multiple years, population growth, advances in technology, and
other factors. Requires the Commissioner to adjust the budget
so that aggregate spending for the state would not exceed
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spending by more than 5%.
20)Requires the Commissioner to project the system's revenues
and expenditures pursuant to specified factors, and to
establish specified budgets for various components of the
health care system and shall include various adjustments
including cost-of-living differences between regions, health
risk of enrollees, workforce development needs, and projected
savings due to improved access and efficiency of care
delivery, among other variables.
21)Requires the Commissioner to seek necessary approval so that
all current federal payments for health care are paid directly
to CHS, which would then assume responsibility for all
benefits and services paid by the federal government with
those funds. Requires the Commissioner to establish formulas
for equitable contributions to CHS from counties and other
local government agencies.
22)Provides that the system would be secondarily responsible for
providing care, to the extent that the federal, state, or
county programs are not transferred to the system. Requires
CHS to cover the Medicare share of cost expenses to the extent
that the Commissioner obtains authorization to incorporate
Medi-Cal or Medicare revenues into the Fund.
23)Permits, until a single public payer for all health care in
the state is established, health care costs to continue to be
collected by "collateral sources" including insurance
policies, health plans, employers, employee benefit contracts,
government benefit programs, judgments for damages, and any
liable third party.
CALIFORNIA HEALTHCARE PREMIUM COMMISSION
24) Establishes the CHPC, composed of 21 members, including 11
elected and appointed state officials, three health
economists, and seven representatives of business, labor, and
non-profit universal health care and taxation policy
organizations.
25) Requires the CHPC to develop an equitable and affordable
premium structure that will generate adequate revenue for the
Fund and ensure stable and actuarially sound funding for the
health insurance system that satisfies the following criteria:
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a) Be means-based and generate adequate revenue to
implement this bill;
b) To the greatest extent possible, ensure that all income
earners and all employers contribute a premium amount that
is affordable and that is consistent with existing funding
sources for health care in California;
c) Maintain the current ratio for aggregate health care
contributions among the traditional health care funding
sources, including employers, individuals, government, and
other sources;
d) Provide a fair distribution of monetary savings achieved
from the establishment of a universal health care system;
e) Coordinate with existing, ongoing funding sources from
federal and state programs;
f) Be consistent with state and federal requirements
governing financial contributions for persons eligible for
existing public programs;
g) Comply with federal requirements; and,
h) Include an exemption for employers and employees who are
subject to a collective bargaining agreement and
participate in a Taft-Hartley Trust Fund that pays the
employer and employee share of the premium to the Fund.
26) Requires the CHPC, on or before January 1, 2013, to submit
a detailed recommendation for a premium structure to the
Governor and the Legislature, and, at least 90 days prior to
that submission, to make a draft recommendation available for
public comment.
GOVERNMENT PAYMENTS
27) Requires the Commissioner to seek necessary approval so
that all current federal payments for health care are paid to
CHS, which would then assume responsibility for all benefits
and services paid by the federal government with those funds.
Requires the Commissioner to seek all necessary waivers or
agreements so that all current state payments for health care
are paid directly to CHS.
28) Requires the Commissioner to establish formulas for
equitable contributions to CHS from counties and other local
government agencies.
29) Provides that the CHS be secondarily responsible for
providing health care to the extent that the federal, state,
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or county programs are not transferred to the CHS.
30) Requires the CHS to incorporate Medi-Cal and Medicare
payments, including premiums, copays, and deductibles, to the
extent that the Commissioner obtains authorization to do so.
FEDERAL PREEMPTION
31) Requires the Commissioner to seek all reasonable means to
secure a repeal or waiver of any provision of federal law that
preempts any part of this bill and, in the event that
preemption is not waived, requires the Commissioner to
promulgate conforming regulations.
32) Requires that employees, entitled to health benefits under
a contract that under federal law preempts provisions of this
bill, seek benefits under that contract before receiving
benefits from CHS.
Subrogation
33) Requires, until the time that the roll of all other payers
for health care have been terminated, that health care costs
be collected from collateral sources when services are
provided under a private insurance policy or other collateral
source.
34) Defines "collateral sources" to include insurance
policies, health plans, employers, employee benefit contracts,
government benefit programs, judgments for damages, and any
liable third party, and to exclude a federally preempted
contract or any service prohibited from subrogation by federal
law.
Eligibility
35) Deems all California residents eligible for CHS, and bases
residency on physical presence in the state with the intent to
reside. States that it is the intent of the Legislature for
CHS to provide health care coverage to state residents who are
temporarily out of the state, as specified.
36) Requires visitors to the state who receive care under CHS
to be billed for all services rendered.
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37) Deems individuals who are eligible for health benefits
from California employers but working in another jurisdiction
to be eligible for benefits under CHS if they make certain
payments.
38) Requires that individuals who arrive at a health facility
unable to document eligibility because of physical or mental
conditions be deemed eligible for services under CHS.
39) Requires the Commissioner to establish an eligibility
waiting period and other criteria needed to ensure the fiscal
stability of CHS if there is an influx of people into the
state for the purposes of receiving medical care.
Benefits
40) Allows any eligible individual to receive services under
CHS from any willing professional health care provider.
41) Provides that covered benefits include all care determined
to be medically appropriate by the consumer's health care
provider.
42) Provides that covered benefits include, but are not
limited to, all of the following:
a) Inpatient and outpatient health facility services;
b) Inpatient and outpatient professional health care
provider services by licensed health care professionals;
c) Diagnostic imaging, laboratory services, and other
diagnostic and evaluative services;
d) Durable medical equipment including prosthetics,
eyeglasses, and hearing aids and their repair;
e) Rehabilitative care;
f) Emergency transportation and necessary transportation
for health care services for disabled in indigent persons;
g) Language interpretation and translation for health care
services;
h) Child and adult immunizations and preventive care;
i) Health education;
j) Hospice care;
aa) Home health care;
bb) Prescription drugs listed on the formulary;
cc) Mental and behavioral health care;
dd) Dental care;
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ee) Podiatric care;
ff) Chiropractic care;
gg) Acupuncture;
hh) Blood and blood products;
ii) Emergency care products;
jj) Vision care;
aaa) Adult day care;
bbb) Case management and coordination to ensure
services necessary to enable a person to remain in the
least restrictive setting;
ccc) Substance abuse treatment;
ddd) Care of up to 100 days in a skilled nursing
facility following hospitalization;
eee) Dialysis;
fff) Benefits offered by a bona fide church, sect,
denomination, or organization whose principles include
healing entirely by prayer or spiritual means;
ggg) Chronic disease management;
hhh) Family planning services and supplies; and,
iii) Early and periodic screening, diagnosis, and
treatment, as specified, for persons less than 21 years of
age.
43) Permits the Commissioner to expand benefits beyond the
minimum outlined above when expansion meets the intent of this
bill and can be sufficiently funded.
44) Excludes the following services from coverage by CHS:
a) Health care services determined by the Commissioner and
chief medical officer to have no medical indication;
b) Services primarily for cosmetic purposes, as specified;
c) Private rooms in inpatient health facilities; and,
d) Services of a provider or facility that is not licensed
by the state.
Delivery of care
45) Permits all licensed and accredited health care providers
in the state to participate in CHS. Prohibits a provider from
refusing to care for a patient solely on the basis of
discrimination that is prohibited by the Fair Employment and
Housing Act.
46) Permits individuals to select a primary care provider, as
specified, and permits women to select an
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obstetrician-gynecologist in addition to a primary care
provider. Permits a specialist to serve as a primary care
provider if the patient and the provider agree to this
arrangement and if the provider agrees to ensure the patient's
care is coordinated.
47) Requires individuals enrolling in integrated health care
systems, group medical practices, or essential community
providers that offer comprehensive services to retain
membership for at least one year after an initial three month
evaluation period, during which they can withdraw at any time.
48) Requires patients to have a referral from a primary care
or emergency care provider, or obstetrician-gynecologist, to
see a specialist, but not to see a dentist, ophthalmologist or
optometrist for a routine vision exam. Permits a patient to
see a specialist without a referral if the patient agrees to
pay the cost of care, or a copayment, if implemented by the
Commissioner. Permits a patient to appeal the denial of a
referral through the dispute resolution mechanism established
by the Commissioner.
49) Permits the Commissioner to establish financial
arrangements with medical providers in other states and
foreign countries in order to facilitate coverage for
California residents who are temporarily out of the state.
50) Permits a patient, during the first six months of CHS
operation, to see a specialist provider without referral, if
the patient had been receiving care from that specialist prior
to CHS.
51) Assigns the director of the Office of Health Planning
various duties, including establishing performance criteria
for health care goals, assisting health care regions in
developing operating and capital budgets, and estimating the
health care workforce and facilities required to meet the
needs of the population.
52) Requires the Office of Health Care Quality to be headed by
the chief medical officer and to establish processes for
measuring the quality of care delivered in the health
insurance system.
53) Assigns various duties to the chief medical officer,
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including establishing evidence-based standards of care for
CHS and implementing systems to measure quality of care and
correct quality of care problems.
54) Requires the patient advocate, in consultation with the
chief medical officer, to do all of the following:
a) Establish a grievance system;
b) Establish an independent medical review system to act as
an independent, external process to provide timely
examinations of disputed health care services and coverage
decisions, as specified;
c) Publicize information concerning the rights of
enrollees, including the right to request an independent
medical review; and,
d) Expeditiously review requests for independent medical
reviews and to immediately notify enrollees whether the
request has been approved.
EXISTING LAW does not provide a system of universal health care
coverage for California residents. Provides for the creation of
various programs to provide health care services to persons who
have limited incomes and meet various eligibility requirements.
These programs include the Healthy Families Program administered
by the Managed Risk Medical Insurance Board, and the Medi-Cal
Program administered by the Department of Health Care Services.
Provides for the regulation of health care service plans by the
Department of Managed Health Care and health insurers by the
Department of Insurance.
FISCAL EFFECT : According to the Senate Appropriations Committee
analysis:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Premium Commission $0 hundreds of thousands toGeneral/
millions of dollars
beginningPrivate
in fiscal year (FY) 2011-2012
through FY 2012-2013 ongoing
costs unknown
CHS Implementation Major implementation cost
pressure of General
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at least $200 billion annually and
ongoing
likely starting in the latter half
of FY 2012-2013
California-specific analyses of single payer proposals have been
completed of SB 921 (Kuehl), and SB 840 (Kuehl), both of which
were previous single payer proposals containing provisions
nearly identical to those in this bill, as well as of SB 1014
(Kuehl), a companion to SB 840, which would have imposed taxes
on employer payroll, employee wages, and other self-employed or
non-wage income, in order to generate revenues to help fund the
proposed single payer system.
In 2005, the Lewin Group, an independent health care policy and
research firm, published an analysis of SB 921 finding that
total health spending for California residents under the current
system was about $184.2 billion in 2006, and that the proposed
single payer program would achieve universal coverage while
reducing total spending in the state by a net $7.9 billion. The
analysis stated that this savings would be realized by reducing
administrative costs within the current system, and savings from
bulk purchasing of prescription drugs and durable medical
equipment. The Lewin Group analysis anticipated a substantial
increase in utilization as a result of universal coverage and
access, but found that the increased utilization would be
substantially offset by roughly $20 billion in administrative
savings and $5.2 billion in bulk purchasing savings.
The Lewin Group analysis stated that the proposed single payer
system would constrain growth in future spending to match growth
in the state gross domestic product, expected to be about 5.14%
annually through 2015. By 2015, the analysis found that health
care spending under the single payer program would be about
$68.9 billion less than projected spending under the current
health care system. The analysis stated that total savings over
the 2006 through 2015 period would be $343.6 billion, with
savings to state and local governments over this ten-year period
of about $43.8 billion.
The Legislative Analyst's Office (LAO) published an analysis of
SB 840 in May 2008. The LAO reviewed and updated the Lewin
analysis with respect to single payer costs and revenues, and
estimated annual costs of $210 billion in 2011, growing to $252
billion in 2015. Additionally, the LAO forecast of costs and
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revenues over the 2011-2015 period showed an estimated annual
shortfall, with costs outpacing revenues by $42 billion in 2011
and $46 billion in 2015. One-half of the shortfall was due to
updated medical cost data over the 2006-2011 period. Another
40% of the shortfall was attributed to California-specific and
actual wage data, resulting in lower revenues than the Lewin
report had assumed. The Lewin report relied on national survey
data rather than actual California data. The remaining 10% of
the shortfall highlighted by the LAO was due to the assumed
costs of funding a reserve, a difference in the availability of
local funding, costs for administration, health care utilization
changes, and costs of drug purchasing.
According to the LAO, payroll taxes for employer and employees
would need to be 16%, combined, for the single payer costs and
revenues to balance at the start of the forecast period. These
taxes are higher than the 12% combined taxation rate that was
proposed in SB 1014.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
needed because existing law has led to a highly fragmented
health finance and delivery system that is administratively
complex and clinically wasteful, leading to billions of
dollars being diverted annually away from direct medical care
and driving unaffordable premium increases. According to the
author, this bill would establish a more efficient finance and
delivery system in order to afford universal coverage while
stabilizing health care spending.
The author notes that health care costs continue to
significantly outpace overall economic growth and cites this
as a significant contributor to the nation's overall economic
recession, rising budgetary deficits, job loss, and medical
bankruptcy. The author states that existing law provides no
mechanism for containing health care spending without
significant reductions in quality and access for consumers.
Absent a single payer model of health care financing, the
author states that growth in health care spending is rapidly
surpassing our ability to afford current levels of benefits or
to add new benefits related to technological improvements.
The author states that, with the passage of federal health
reform, the establishment of a single payer model of health
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care is particularly critical because the economic pressures
of rising health care costs will no longer have an escape
valve of rising uninsurance or lowered benefits. Taxes that
fund public programs, and wages that fund mandatory private
insurance, will both grow much more slowly than rising health
insurance premiums. Thus, the author states that the urgency
for effective cost containment will substantially increase
under federal health reform and necessitate movement toward a
single payer finance model.
The author states that a single payer model of health care
financing has been demonstrated to contain health care
spending while providing universal coverage through reduced
administrative overhead and more effective use of consumer
purchasing power. The author cites that the United States
leads the world in health care spending at about $7,700 per
person per year on average, more than twice the average in
other industrialized countries. Despite our high level of
spending, the U.S. ranks 37th in population-based health
outcome measurements according to the World Health
Organization, well below the rankings of all other
industrialized nations.
The author states that steeply rising health care costs are
extremley burdensome on companies doing business in the United
States, putting them at a substantial competitive disadvantage
in the international marketplace. While health insurance
premiums are rising unpredictably, often by as much as 20% in
one year, employers, large and small, unions, and even
powerful purchasers such as the California Public Employee
Retirement System, are no longer able to stabilize health care
costs or benefits through negotiations. The author believes
that a single payer model of health care financing, which
removes private insurance as a middleman between the patient
and health care providers is essential to containing these
rising costs.
The author states that under a single payer health care
system, California employers would achieve significant savings
on their employee benefit costs, thereby stimulating job
creation and economic recovery. In addition, the author
states that this bill would lead to significant increases in
investments in electronic medical infrastructure also spurring
job creation and international competitiveness. The author
further states that this bill will reduce state and local
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government costs for employee health care and retiree health
care costs. For example, Los Angeles Unified School District
estimated $100 million in annual savings on employee and
retiree benefit costs.
The author states that 20 to 30% of the health care dollar is
spent on administration (excluding profit) and that health
care providers spend increasing amounts of time navigating the
porous network of public and private health insurance
programs. For example, the University of California - San
Francisco Children's Hospital works with nearly 80 different
health insurance policies and public programs each with its
own benefits package, formulary schedule, and rate of
co-payments and deductibles. One medical group practice
serving 70,000 patients works with 6,000 different health
insurance plans.
According to the author, our current system fragments and
dilutes the purchasing power of Californians with regard to
pharmaceuticals and medical equipment. The author states that
Americans are frequently paying about 50% more than Europeans,
Australians, Japanese, and Canadians for the same
pharmaceuticals produced by the same companies. This could be
changed if California implemented bulk purchasing of
pharmaceuticals and medical equipment under this bill.
2)BACKGROUND . According to the California HealthCare Foundation
(Foundation), an average of 6.6 million Californians were
uninsured over the three year period of 2006-2008. California
has the largest number of uninsured residents in the United
States and the eighth largest proportion of uninsured in the
nation (20.5% of the population). Of those, 5.6 million were
adults and 1.1 million were children. Fifty-five percent of
Californians have employment based coverage, 17% get coverage
through Medicaid, and 8% purchase coverage through the
individual insurance market.
The Foundation also reports that employer based coverage in
California from 1988-2008 declined from 65% to 56%, with
government sponsored coverage increasing from 16% to 20%,
individually purchased coverage increasing from 7% to 8% and
the percentage of uninsured increasing from 18% to 21%.
Forty-one percent of the uninsured in California have incomes
below $25,000 annually.
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Latinos are much more likely to be uninsured than any other
ethnic group, as 58% of the uninsured are Latino. However,
unlike Latinos and African Americans, whose high rates of
being uninsured have either held steady or slightly declined
for the last five years, the likelihood of being uninsured is
now growing for Whites and Asians.
3)FEDERAL HEALTH CARE REFORM . On March 23, 2010, President
Obama signed the Patient and Protection and Affordable Care
Act (PPACA); P. L. 111-148, as amended by the Health Care and
Education Reconciliation Act of 2010; P. L. 111-152. Among
other provisions, the new law makes significant statutory
changes affecting the health insurance market, including a
requirement that health plans cover an essential health
benefits package, at a minimum, with some exceptions, the
establishment of four benefit categories that must be offered
by health insurers, an individual mandate, a prohibition
against setting lifetime limits on the dollar value of
benefits and from setting unreasonable annual limits on the
dollar value of benefits, a Prohibition Against Rescissions,
and the creation of a national high-risk pool.
PPACA also includes a "Waiver for State innovation" provision.
This section permits states to apply to the U.S. Health and
Human Services Secretary for the waiver of specified
requirements beginning in January 1, 2017, so long as the
substituted plan will:
a) Provide coverage that is at least as comprehensive as
the coverage defined in PPACA and offered through Exchanges
b) Provide coverage and cost sharing protections against
excessive out-of-pocket spending that are at least as
affordable as the provisions of this title would provide;
c) Provide coverage to at least a comparable number of its
residents as the provisions of the PPACA would provide; and
d) Does not increase the Federal deficit.
1)SUPPORT . Supporters state that as health insurance costs
steadily rise, employers are increasingly reducing or dropping
coverage for employees, that the increase in high deductible
health plans, which require deductibles and co-payments which
are generally unaffordable, have failed to stem the rise in
health care costs, and that half of all bankruptcies in the
United States are now related to medical costs. Supporters
cite this as evidence that Californians can no longer rely on
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the current system of private insurance, as no one is
guaranteed to receive care when they become ill, and many who
are insured often have inadequate coverage. Supporters state
that this bill would provide every Californian with health
care coverage that would provide comprehensive benefits and a
high quality of care. Supporters state that this bill would
simplify the currently complex, multi-payer system, eliminate
billions of dollars in administrative waste, generate savings
through increased access to primary and preventive care, as
well as bulk purchasing of prescription drugs and durable
medical equipment, allow patients to choose their own doctors,
eliminate coverage exclusions for preexisting conditions, and
ensure continued coverage regardless of employment status.
The County Health Executives Association of California (CHEAC)
would support the bill if amended to relieve counties of their
requirements to provide health care to indigent and dependent
poor persons. CHEAC states that with the implementation of
universal health coverage, there will no longer be a need for
this requirement on counties. Additionally, CHEAC argues that
local public health funding must be preserved, and that health
realignment revenues dedicated to communicable disease
control, epidemiology, public health laboratories, and public
health nursing should be maintained at the local level.
2)OPPOSITION . Opponents state that costs associated with this
bill would create an expensive labyrinth of bureaucracy, and
that competition among private companies leads to lower costs
and better care. Opponents assert that a state-run health
care system would eliminate private health plans and insurers,
thereby forcing people to rely upon the state to take care of
their health needs, and limiting medical advances because of
decreased competition. Opponents argue that this bill would
extend taxpayer obligations too far, and damage the state's
competitiveness for jobs. They state it would be impossible
to replace the current system of health care without major
increases in taxes, both to cover currently insured
individuals, as well as the uninsured, which would discourage
business growth, and hurt state investments, and that
out-of-state individuals would move to California to take
advantage of the new health care system adding to the state's
economic burden. Opponents disagree with the premise that a
single payer system will generate substantial savings from
lowered administrative costs and profits, as administrative
costs will not be eliminated under a single payer system.
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They assert that competitive forces in the marketplace are
vital in health care, and that while California's premiums
have increased, they are still lower than other large markets.
Opponents also state that single payer systems in other
countries have demonstrated limited access and longer waiting
times for services.
3)PREVIOUS LEGISLATION . SB 840 (Kuehl) of 2008, SB 840 (Kuehl)
of 2006, and SB 921 (Kuehl) of 2004 would have implemented a
system substantially similar to that proposed by this bill.
SB 840 was vetoed in 2008 and 2006. SB 921 was held in the
Assembly Appropriations Committee.
SB 1014 (Kuehl) of 2008, a companion to the version of SB 840
of 2008 introduced in the 2007-2008 legislative session, would
have imposed specified health care coverage taxes on employer
payroll, employee wages, self-employment income, and other
non-wage income, as specified, and direct revenues generated
from these taxes to fund the single payer system that would
have been created by SB 840. SB 1014 was held by the Senate
Revenue and Taxation Committee.
AB 1 X1 (Nunez, 2008) would have required all California
residents to carry a minimum level of health insurance
coverage for themselves as well as for their dependents,
established a state purchasing pool through which qualifying
individuals would be allowed to obtain subsidized or
unsubsidized health care coverage, expanded eligibility for
the Medi-Cal and Healthy Families programs, and increased
Medi-Cal provider rates for hospitals and physician services.
Would have required health plans and insurers to offer and
renew, on a guaranteed basis, individual coverage in five
designated coverage categories, regardless of the age, health
status, or claims experience of applicants, and established
new modified community rating rules for the pricing of
individual coverage. Would have contained provisions intended
to reduce or offset a portion of the costs of health coverage
as well as several new programs and initiatives related to the
prevention and promotion of health and wellness, and would
have expressed intent that financing for the bill's provisions
come from a variety of sources, including federal funds, fees
from employers, revenues from counties, fees paid by acute
care hospitals, premium payments from individuals, and funds
from a new tobacco tax. Some of these financing measures
would have been contained in a proposed ballot initiative. AB
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1 X1 failed passage in the Senate Health Committee.
SB 48 (Perata) of 2007 proposed a health care reform plan
designed to insure all working Californians and their
dependents, as well as all children regardless of residency
status in households with incomes up to 300% of the federal
poverty level (FPL). These provisions were deleted and
subsequently replaced with different provisions that did not
pertain to health care reform.
AB 8 (Nunez) of 2007 proposed a health care reform plan
designed to insure all working individuals and dependents
employed by firms of two or more employees, all children,
regardless of residency status, with household incomes up to
300% FPL, and eventually low-income childless adults. AB 8
was vetoed.
SB 32 (Steinberg) and AB 1 (Laird) of 2008 would have expanded
eligibility for Healthy Families to children with family
incomes at or below 300% FPL and would have deleted the
specified citizenship and immigration status requirements for
children to be eligible for Medi-Cal and Healthy Families. SB
32 would have also allowed applicants to self-certify their
income and assets for the purposes of establishing eligibility
for Healthy Families, and would have established a Medi-Cal
presumptive eligibility program, as specified. SB 32 was
placed on the Assembly inactive file, and AB 1 was held on the
Assembly floor.
SB 2 (Burton), Chapter 673, Statutes of 2003, enacted the
Health Insurance Act of 2003, to provide health coverage to
employees (and in some cases their dependents) who do not
receive job-based coverage and who work for large and medium
employers. SB 2 was repealed by Proposition 72, a voter
referendum on the November 2004 ballot.
REGISTERED SUPPORT / OPPOSITION :
Support
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California Nurses Association (cosponsor)
California School Employees Association (cosponsor)
Affiliated Property Craftspersons Local 44
Alameda-Contra Costa Transit District
Alameda County Board of Supervisors
All City Employees Association, Local 3090 AFSCME
Alliance for Democracy, Mendocino Coast
AP Goodyear Construction
American Association of University Women
American Association of University Women, Goleta Valley
American Association of University Women, Pasadena Branch
American Association of University Women, Santa Maria
American Civil Liberties Union, Southern California
American Federation of State, County and Municipal Employees,
AFL-CIO (AFSCME)
AFSCME, AFL-CIO District Council 36
AFSCME, AFL-CIO District Council 57
AFSCME, AFL-CIO Local 444
AFSCME, AFL-CIO Local 955
AFSCME, AFL-CIO Local 2019
AFSCME, AFL, CIO Local 2428
AFSCME Retirees Chapter 36
American Federation of Television and Radio Artists
American Medical Students Association, National
American Medical Students Association, Davis School of Medicine
chapter
American Medical Students Association, UCLA Pre-medical Chapter
Asian and Pacific Islander American Health Forum (APIAHF) -
5/28/2010
Association of Retired Teachers
Bay Area Veterans of the Civil Rights Movement
Bell-Everman, Inc. (Goleta, CA)
California Advocates for Nursing Home Reform (CANHR)
California Association of Alcohol and Drug Programs (CAADPE)
California Alliance for Retired Americans
California Commission on the Status of Women
California Communities United Institute
California Federation of Teachers
California Foundation for Independent Living Centers
California Health Professional Student Alliance
California Labor Federation, AFL-CIO
California Maternal, Child and Adolescent Health Directors
(MCAH)
California Nurses Association/National Nurses Organizing
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Committee
California Pan-Ethnic Health Network
California Physicians Alliance
California Professional Firefighters
California Retired Teachers Association
California Retired Teachers Association - Santa Barbara Division
California Senior Coalition
California Senior Legislature
California Society for Clinical Social Work
California Student Physicians for Healthcare Reform
California Teachers Association
California Women's Agenda (CAWA)
City of Albany
City of Berkeley
City of El Cerrito
City of Oakland
City of San Pablo
City of Santa Barbara
City of Santa Cruz
City of Santa Monica
City of Watsonville
Coalition of Lavender-Americans on Smoking and Health
Coastside Democrats
Concerned Citizens of Laguna Woods Village
Congress of California Seniors
Consumer Federation of California
Contra Costa County Advisory Council on Aging
Contra Costa County, Board of Supervisors
County Health Executives Association of California
Democratic Alliance for Action
Democratic Party of Contra Costa County
Democratic Women of Santa Barbara County
Democrats of Rossmoor (Walnut Creek)
Diablo Valley Democratic Club
Doctors Medical Center, West Contra Costa County
East Bay Peace Action
Easter Hill United Methodist Church
El Cerrito Democratic Club
Elsdon, Inc., (Danville, CA small business)
Evergreen Democratic Club
Federation of Retired Union Members of Santa Clara County
Glass, Molders, Pottery, Plastics and Allied Workers Union,
Retirees Branch 7
Glendale City Employees Association
Gray Panthers California
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Having Our Say
Health Access of California
Health Care for All - California
Health Care for All, Contra Costa County
Health Care for All, Santa Barbara County
Health Officers Association of California
Hubert Humphrey Democratic Club
Humanist Society of Santa Barbara
International Alliance Theatrical Stage Employees Local 33
International Alliance of Theatrical State Employees Local 44
International Association of Machinists
The Kennedy Club of San Joaquin
Kramer Translation
Labor Task Force for Universal Health Care
Lamorinda Democratic Club
Lamorinda Peace and Justice Group
League of Women Voters, California
League of Women Voters, Berkeley, Albany, and Emeryville
League of Women Voters, Davis
League of Women Voters, Diablo Valley
League of Women Voters, El Dorado County
League of Women Voters, Oakland
League of Women Voters, Palos Verdes Peninsula/San Pedro
League of Women Voters, Santa Barbara
League of Women Voters, San Diego County
League of Women Voters, San Joaquin County
League of Women Voters, San Jose/Santa Clara
League of Women Voters, Santa Cruz County
League of Women Voters, Santa Maria Valley
League of Women Voters, Southwest Santa Clara Valley
League of Women Voters, West Contra Costa County
Librarians' Guild, AFSCME District Council 36, Local 2626
Los Angeles County Democratic Party
Los Angeles Unified School District
Lumina Media Productions (Richmond, CA)
Lutheran Office of Public Policy
Mane Event Salon, Grass Valley
Manteca Democratic Club
Marin County Board of Supervisors
National Association of Social Workers, California chapter
National Council of Jewish Women, Long Beach
North Richmond Municipal Advisory Council
Nursing Student Association at SFSU
Officescapes, Newport Beach, CA
Old Lesbians Organizing for Change
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Older Women's League of California
Older Women's League, East Bay
Older Women's League - San Francisco Chapter
Palm Desert Greens Democratic Club
People's Democratic Club of Santa Cruz
Professional Musicians, Local 47
Progressive Democrats of America
Progressive Jewish Alliance
Promotores de Salud of Behavioral Health Services
Pueblo Action Fund
Rainbow Coalition, West Contra Costa
Resources for Independent Living
Retired Public Employees Association
Richmond Commission on Aging
Richmond Progressive Alliance
Richmond Vision
San Bernardino Public Employees Association
San Diego Unified School District
San Fernando Valley Interfaith Council
San Francisco Community Clinic Consortium
San Francisco Gray Panthers
San Francisco Tobacco Free Coalition
San Gabriel Valley Democratic Women's Club
San Jose Peace and Justice Center
San Luis Obispo County Employees Association
San Mateo County Central Labor Council, AFL-CIO
Santa Barbara County Action Network
Santa Barbara County Democratic Central Committee
Santa Barbara Friends Meeting, Quakers
Santa Clara County, Board of Supervisors
Santa Clara County Democratic Club
Santa Clarita Valley Clean Money for Better Government Committee
Santa Cruz County, Board of Supervisors
Santa Monica Community College District
Santa Rosa City Employees Association
Senior Action Network
Senior Advocacy Council of Pasadena
Service Employees International Union (SEIU)
Service Employees International Union, Local 521
Social Justice Alliance
Spokewise Graphic Design, small business
St. John's Presbyterian Church, Mission and Justice Commission
(Berkeley, CA)
St. Mark Presbyterian Church, Health Ministries Commission
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(Newport Beach)
St. Mary's Center
Stanislaus and Tuolumne County Central Labor Council, AFL-CIO
Students of University of CA Program in Medical Education
Torrance Democratic Club
Union for Reform Judaism, Pacific Southwest Council
Unitarian Society of Santa Barbara
Unitarian Universalist Legislative Ministry, California
Unitarian Universalist Fellowship of Santa Cruz County
Unite Here HERE Local 11
United Auto Workers Region 5, Community Action Program
United Electrical, Radio and Machine Workers of America, Local
1004
United Electrical, Radio and Machine Workers of America, Local
1421
United Educators of San Francisco
United Nations Association-USA, Santa Barbara and TriCounties
chapter
United Nurses Assoc. of California/Union of Health Care
Professionals
United Steelworkers, Local 675
United Steelworkers, Local 1440, AFL-CIO
United Teachers Los Angeles (UTLA)
Valley Women's Club
Westside Progressives, Marina Del Ray
Wellstone Democratic Renewal Club
West Contra Costa Concilio Latino
West Contra Costa Latina/o Democratic Club
West Contra Costa Unified School District
Western Center on Law & Poverty
Women's Health Specialists
Women's International League for Peace and Freedom - Peninsula
Branch
Women's International League for Peace and Freedom - Santa Cruz
Branch
Over a hundred individuals
Opposition
America's Health Insurance Plans
Anthem
Association of California Life and Health Insurance Companies
Blue Shield of California
California Association of Health Plans
California Association of Joint Powers Authorities
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California Chamber of Commerce
California Medical Association
California Right to Life Committee, Inc.
California Taxpayers Association
Concerned Women for America
Corona Chamber of Commerce
Department of Managed Health Care
Health Net
Irvine Chamber of Commerce
Long Beach Area Chamber of Commerce
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097