BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 155|
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THIRD READING
Bill No: SB 155
Author: Evans (D)
Amended: 5/4/11
Vote: 21
SENATE HEALTH COMMITTEE : 7-1, 4/27/11
AYES: Hernandez, Alquist, Blakeslee, De Le�n, DeSaulnier,
Rubio, Wolk
NOES: Anderson
NO VOTE RECORDED: Strickland
SENATE APPROPRIATIONS COMMITTEE : 6-3, 5/26/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Emmerson, Runner
SUBJECT : Maternity services
SOURCE : American Congress of Oncologists and
Gynecologists,
District IV
California Commission on the Status of Women
Kaiser Permanente
DIGEST : This bill requires every individual or group
health insurance policy, as specified, to cover maternity
services, as defined.
ANALYSIS :
Existing federal law :
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1. Requires employers, under the Federal Civil Rights Act,
that offer health insurance and have 15 or more
employees, to cover maternity services benefits at the
same level as other health care benefits.
2 .Defines, under the Patient Protection and Affordable
Care Act (PPACA) (Public Law 111-148), as amended by the
Health Care Education and Reconciliation Act of 2010
(Public Law 111-152), a list of "essential health
benefits package," including maternal and newborn care,
which health insurance coverage and group health plans
must provide beginning in 2014.
Existing state law :
1. Provides for the regulation of health plans and insurers
by the Department of Managed Health Care (DMHC) and the
California Department of Insurance (CDI), respectively.
2. Requires DMHC-regulated health plans to provide all
medically necessary basic health care services, as
defined.
3. Permits DMHC to define the scope of the services and to
exempt plans from the requirement for good cause.
4. Specifies that basic health care services include
maternity services necessary to prevent serious
deterioration of the health of the enrollee or the
enrollee's fetus, and preventive health care services,
specifically including prenatal care. No similar
provision is applicable to health insurers regulated by
CDI.
5. Prohibits health plans and insurers from issuing
contracts and policies that contain a copayment or
deductible for inpatient hospital or ambulatory care for
maternity services that exceeds the most common amount
charged for the same type of care and service provided
for other covered medical conditions.
6. Prohibits health plans and insurers that provide
maternity benefits from attaching any exclusions,
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reductions, or limitations to coverage for involuntary
complications of pregnancy, unless those provisions
apply to all of the benefits paid by the plan or
insurer.
7. Prohibits health plans and insurers from gender rating,
or charging differential premiums based on gender for
contracts issued, amended, or renewed on or before
January 1, 2011.
This bill:
1. Requires any health insurer with a pending or approved
individual or group health insurance policy form on file
with CDI as of January 1, 2012, to submit to CDI, on or
before March 1, 2012, a revised policy form that
provides coverage for maternity services.
2. Requires new forms for individual or group policies
submitted to CDI after January 1, 2012, to provide
coverage for maternity services.
3. Requires the corresponding policy, issued, amended, or
renewed on or after 30 days following CDI's approval of
the revised form, to include coverage for maternity
services.
4. Defines "maternity services" to include prenatal care,
ambulatory care for maternity services, involuntary
complications of pregnancy, neonatal care, and inpatient
hospital maternity care, including labor and delivery,
and postpartum care.
5. States that the above definition of "maternity services
" will remain in effect until such time as federal
regulations define the scope of benefits to be provided
under the maternity benefit requirement of that act.
6. Exempts specialized health insurance, Medicare
supplement insurance, short-term limited duration health
insurance, Civilian Health and Medical Program of the
Uniformed Services supplemental insurance, TRI-CARE
supplemental insurance, and hospital indemnity,
accident-only, or specified disease insurance from these
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requirements.
Background
Value of prenatal care . A 2008 report from the National
Women's Law Center entitled "Nowhere to Turn: How the
Individual Health Insurance Market Fails Women" found that
it is difficult and costly for women to find health
insurance that covers pregnancy-related care.
Numerous studies have shown that prenatal care pays for
itself by helping to minimize the prevalence and severity
of low- and very low birthweight babies. A 2004 study in
the Journal of Perinatal and Neonatal Nursing evaluated the
effects of augmented prenatal care on women at high-risk
for having a low-birth weight baby who were enrolled in a
special program that provided basic prenatal care, prenatal
education, and case management. The program saved about
$13,962 per single, low birthweight birth prevented, and,
after program costs were considered, the return on
investment equaled 37 percent (for every dollar invested in
the program $1.37 was saved).
An American College of Obstetricians and Gynecologists
study of over 3,000 women estimated that each dollar cut
from prenatal care could cost taxpayers up to $3.33 in
neonatal care for sick babies. The March of Dimes reports
that premature birth is among the most common, serious, and
costly problems facing infants in the United States, and is
responsible for about half of all infant hospitalizations.
According to the California Department of Public Health, in
2006, 85.9 percent of births were to mothers who initiated
prenatal care in the first trimester. Only 0.6 percent of
California women received no prenatal care. Overall in
California, there are approximately 75 maternal
pregnancy-related deaths and 3,000 infant deaths per year.
Infant mortality is most frequently caused by birth defects
(23.5 percent of deaths), followed by prematurity and low
birthweight (15.6 percent of deaths), maternal
complications of pregnancy (6.0 percent of deaths), and
Sudden Infant Death Syndrome (5.2 percent of deaths).
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FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
Cost pressure to $49-$244 $98-$489
$98-$489County/*
provide care for newly
Federal
uninsured persons
*Costs could be shared equally between county and federal
funds, or could be all county funds.
SUPPORT : (Verified 5/26/11)
American Congress of Oncologists and Gynecologists,
District IV
(co-source)
California Commission on the Status of Women (co-source)
Kaiser Permanente (co-source)
American Academy of Pediatrics, California
American Civil Liberties Union
American Federation of State, County, and Municipal
Employees California Academy of Family Physicians
California Association of Physician Groups
California Congress of Seniors
California Department of Insurance
California Medical Association
California National Organization for Women
California Nurses Association
California Pan-Ethnic Health Network
California Primary Care Association
California Teachers Association
California Women's Law Center
First 5 Los Angeles
Having Our Say Coalition
Local Health Plans of California
March of Dimes Foundation
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Maternal and Child Health Access
National Association of Social Workers, California
NARAL Pro-Choice California
Nevada County Citizens for Choice
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
United Nurses Assoc. of California/Union of Health Care
Professionals
Women's Health Specialists
OPPOSITION : (Verified 5/26/11)
America's Health Insurance Plans
Association of California Life and Health Insurance
Companies
California Chamber of Commerce
ARGUMENTS IN SUPPORT : The California Commission on the
Status of Women and the American Congress of Obstetricians
and Gynecologists, sponsors of this bill, argue that since
only women are biologically able to have children, they are
the ones who need to buy the more expensive policies and
bear the burden of the increased cost. The sponsors add
that this economic burden is magnified by the fact that
women on average make only 77 percent of men's wages, have
less ability to pay expensive health costs, and the burden
is more substantial for women of color whose average wages
are less. The sponsors contend that the resulting
disproportionate costs for men and women to obtain coverage
for their basic medical needs constitutes gender
discrimination, that maternity care is basic and preventive
health care; and that the law should not allow the sale of
insurance policies that discriminate against women.
Proponents of this bill state that DMHC-regulated health
plans are already required to include maternity services
and this bill would bring CDI-regulated policies into
conformity, pointing out that insurance products in the
individual market that do not carry comprehensive maternity
coverage offer selective health care that is not in the
best interest of women. Proponents add that lack of
coverage for prenatal care, delivery, and perinatal
services can have serious health and cost ramifications for
both the mother and the newborn. Proponents of this bill
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contend that if an insurer fails to provide maternity
coverage, the state picks up the cost, whether for prenatal
care provided through a public program or the costs
associated with lack of prenatal care and that this bill
closes a gap in existing law.
ARGUMENTS IN OPPOSITION : Opponents of this bill include
health insurers and the California Chamber of Commerce who
argue that, because federal law already requires group
insurance policies to include maternity benefits, the
mandate in this bill is an individual market competition
issue, rather than a health insurance access or equity
issue. Opponents argue that by eliminating choice, this
bill negatively impacts women and men who have made a
conscious decision not to buy maternity services, and women
who are unable to have children, by forcing them to
purchase coverage for services they do not want or need.
Opponents argue that the 15 mandate bills introduced this
session add to over 87 mandates already in statute and will
further erode affordable health insurance options for
insureds. Opponents contend that this bill is premature
and could further exacerbate California's budget crisis if
the benefits mandated in this bill exceed the benefits
mandated in federal health care reform. In addition, this
bill will increase costs in the private sector at a time
when the state is still struggling through an economic
crisis, as evidenced by one of the highest unemployment
rates in the nation.
CTW:do 5/27/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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