BILL ANALYSIS �
SB 155
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Date of Hearing: August 17, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 155 (Evans) - As Amended: June 28, 2011
Policy Committee: HealthVote:13-1
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
health plans must cover maternity benefits under current law.
Specifically, this bill:
1)Requires maternity services to include prenatal care,
ambulatory care maternity services, involuntary complications
of pregnancy, neonatal care, and inpatient hospital maternity
care, including labor and delivery and postpartum care.
2)Conforms the definition of maternity services for purposes of
this bill to that adopted through future federal regulations
pursuant to the Patient Protection and Affordable Care Act
(ACA) (PL-111-148).
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/Access for Infants and Mothers (AIM).
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
SB 155
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law, the ACA, 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.
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, most 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 SB 155 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
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services. AB 155 (Hern�ndez) is substantially similar to this
bill and is pending on the Suspense File of this committee.
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.
4)Other Mandates in the Current Session . There are fourteen
health mandates that were introduced this year, including SB
155. Remaining 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 185 (Maternity Services)
f) AB 310 (Ma): Prescription Drugs
g) AB 369 (Huffman): Pain Prescriptions
h) AB 428 (Portantino): Fertility Preservation
i) AB 652 (Mitchell): Child Health Assessments
j) AB 1000 (Perea): Cancer Treatment
aa) SB 255 (Pavley): Breast Cancer
All of the Assembly Bills listed above were heard in this
committee in Spring 2011 and are pending on this committee's
Suspense File. SB 255 is pending in Senate Health Committee.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081