BILL ANALYSIS �
AB 72
Page 1
Date of Hearing: May 11, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 72 (Eng) - As Amended: April 4, 2011
Policy Committee: HealthVote:13-5
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires group health plan contracts and group health
insurance policies, including health policies provided to public
employees, to provide require coverage of services provided by
acupuncturists.
FISCAL EFFECT
1)According to the California Health Benefits Review Program
(CHBRP), state costs of $11.7 million ($6.8 million GF) to
provide coverage to public employees through CalPERS HMOs.
This bill would not apply to plans offered through Medi-Cal or
Healthy Families.
2)Increased employer-funded premium costs in the private
insurance market of approximately $32 million.
3)Increased employee contributions for group health insurance
statewide of $11.5 million, and co-payments of $20 million.
Increased costs are estimated to be offset by a reduction in
out-of-pocket costs for policyholders of $67 million.
4)CHBRP notes that because this bill is a mandate to reimburse
for treatments delivered by acupuncturists, the impact of the
proposed benefit mandate is dependent on future changes in the
Business and Professions Code and determinations of scope of
practice.
5)Federal regulations implementing the federal health reform
law, the Patient Protection and Affordable Care Act (ACA)
(PL-111-148), may impact the costs of this bill in future
years. At this time, it is unclear whether there may be
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additional future state costs associated with this bill.
COMMENTS
1)Rationale . The author states that current law only requires
acupuncture to be offered but not covered under group
contracts and, as a result, it fails to acknowledge that
acupuncture is an effective treatment for many health
conditions. The author notes that many of the five million
Asian Americans living in California, who account for
approximately 14% of the state's population, value
acupuncturists as their providers of choice. The author
maintains that this bill will result in the avoidance of
surgery and fewer hospital visits by ensuring that millions of
Californians will have access to this efficacious and
cost-effective therapy through their health insurance.
2)Mandates and the Affordable Care Act (ACA). The ACA creates
new state-run health insurance exchanges that will likely
provide coverage to millions of Californians beginning in
2014, and requires that health plans offered through an
exchange cover certain categories of benefits, called
Essential Health Benefits (EHBs).The Secretary of Health and
Human Services (HSS) is expected to publish guidance later in
2011 and 2012 that will further define these categories. These
definitions will have important fiscal implications for the
state.
The ACA specifies that if states require plans in the exchange
to offer additional benefits that go beyond the defined EHBs,
then states must pay the additional cost related to those
mandates. At this time, there are a number of outstanding
questions related to how federally defined EHBs will interact
with state-level benefit mandates.
According to federal law, EHBs are to resemble what is
typically included in an employer health plan. There is
variation among large and small group employer plans regarding
coverage of acupuncture services. Therefore it is unclear
whether EHBs would be defined to include acupuncture services
and whether, beginning in 2014, this bill would result in
increased state costs.
3)Related Legislation . AB 54 (Dymally) in 2007 required health
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care service plans and health insurers to provide coverage for
acupuncture under specified group policies and created several
exemptions to this requirement, including health coverage
provided to public employees. AB 54 was vetoed due to
affordability concerns with regard to health coverage and the
premium pressures created by this and other health mandates.
SB 573 (Burton) of 2002, which was substantially similar to
this bill, was referred to the Assembly Health Committee but
was never heard.
4)Other Mandates in the Current Session . There are 14 health
mandates proposed this year, including AB 72. Other mandates
in the current session include:
a) AB 137 (Portantino): Mammography
b) AB 154 (Beall): Mental Health Services
c) AB 171 (Beall): Autism
d) AB 185 (Hernandez): Maternity Services
e) AB 310 (Ma): Prescription Drugs
f) AB 369 (Huffman): Pain Prescriptions
g) AB 428 (Portantino): Fertility Preservation
h) AB 652 (Mitchell): Child Health Assessments
i) AB 1000 (Perea): Cancer Treatment
j) SB 136 (Yee): Tobacco Cessation
aa) SB 155 (Evans): Maternity Services
bb) SB 173 (Simitian): Mammograms
cc) SB 255 (Pavley): Breast Cancer
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081