BILL ANALYSIS �
AB 428
Page 1
Date of Hearing: May 11, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 428 (Portantino) - As Amended: April 27, 2011
Policy Committee: HealthVote:13-6
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health plan contracts and health insurance
policies to cover fertility preservation services when fertility
may be lost due to a medical intervention.
FISCAL EFFECT
1)According to the California Health Benefits Review Program
(CHBRP), state costs of $1.3 million ($670,000 GF) for
Medi-Cal managed care plans, plans provided through the
Managed Risk Medical Insurance Board (MRMIB), and CalPERS HMOs
plans.
2)Increased employer-funded premium costs in the private
insurance market of approximately $4.9 million.
3)Increased premium expenditures by employees and individuals
purchasing insurance of $2.3 million, and cost-sharing of $1.2
million for newly covered benefits. Increased costs are
estimated to be offset by a reduction in out-of-pocket costs
for policyholders of $3.2 million.
4)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. Since fertility preservation services are not commonly
covered services, it seems likely that this bill will result
in additional future state costs. These costs would likely not
exceed the low millions of dollars.
COMMENTS
AB 428
Page 2
1)Rationale . According to the author, the intent of this bill is
to reduce the financial burden associated with fertility
preservation treatments among those undergoing treatment for
cancer and other diseases, and to ensure that treatment
decisions are based on medical effectiveness and not on the
risk of fertility loss. CHBRP indicates that the most
commonly fertility preservation services cost approximately
$400 for men and $15,000 for women.
2)Coverage under current law. Current law requires plans and
insurers to offer coverage of infertility services to group
purchasers, but does not require group purchasers to provide
infertility coverage. This bill does not affect coverage for
infertility services.
The author of this bill indicates that other iatrogenic
conditions (conditions caused by medical treatment) such as
breast reconstruction after mastectomy are commonly covered.
However, CHBRP estimates that only 5% of individuals enrolled
in group insurance currently have coverage for iatrogenic
infertility.
3)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 federal 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.
Since the EHB package will be based on what is covered in a
typical employer plan and most employers currently do not
cover fertility preservation, it is likely that the mandate in
this bill will exceed the federally defined EHBs. Therefore,
it seems likely that there will be future state costs
AB 428
Page 3
associated with the mandate that plans in the exchange provide
coverage for fertility preservation services.
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