BILL ANALYSIS Ó
AB 185
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Date of Hearing: April 13, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 185 (Hernández) - As Introduced: January 25, 2011
Policy Committee: HealthVote:12-5
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires policies in the individual and group health
insurance markets to provide coverage for maternity services.
This bill creates a mandate on insurers and not health plans, as
maternity benefits are already mandated for health plans. This
bill requires maternity services to include prenatal care,
ambulatory care, care for pregnancy complications, neonatal
care, inpatient hospital maternity care, and postpartum care.
FISCAL EFFECT
1)According to the California Health Benefits Review Program
(CHBRP), no direct state fiscal impact for publicly supported
health coverage provided through Medi-Cal, CalPERS, or Healthy
Families.
2) Increased premium costs in the
individual insurance market of approximately $110 million.
Increased premium costs are estimated to be offset by a
reduction in out-of-pocket costs for women who would otherwise
pay for a variety of services not covered by insurance in the
absence of this mandate.
3)Federal regulations implementing the federal health reform
law, the Patient Protection and Affordable Care Act (ACA)
(PL-111-148), may reduce the fiscal impact of this bill in
future years. The federal law requires maternity services to
be covered as a basic benefit in state-run health insurance
exchanges that will provide health coverage to millions of
individuals.
AB 185
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COMMENTS
1)Rationale . This bill intends to ensure fair and affordable
access to maternity care in all health insurance policies.
Currently, 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, some products in the individual
market do not provide maternity-related coverage. This bill
establishes a requirement in this market.
2)Mandates and the Affordable Care Act . The ACA creates new
state-run health insurance exchanges that will likely provide
coverage to millions of Californians, 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. However, CHBRP concludes that because "maternity
services" as defined under AB 185 are likely to be considered
part of EHBs, it is unlikely that there would be an additional
fiscal liability to the state as a result of this mandate.
3)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
services.
AB 1825 (De LA Torre) in 2010, AB 98 (De La Torre) in 2009 and
AB 1962 (De La Torre) in 2008 were similar to this bill. Each
bill was vetoed due to affordability concerns with regard to
health coverage and the premium pressures created by this and
other health mandates.
AB 185
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4)Other Mandates in the Current Session . There are fourteen
health mandates that were introduced this year, including AB
185. Other mandates in the current session include:
a) AB 72 (Eng): Acupuncture
b) AB 137 (Portantino): Mammography
c) AB 154 (Beall): Mental Health Services
d) AB 171 (Beall): Autism
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