BILL ANALYSIS Ó
AB 175
Page 1
Date of Hearing: January 14, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 175 (V. Manuel Pérez) - As Amended: January 6, 2014
SUBJECT : Health care coverage.
SUMMARY : Establishes the Uncovered Worker Health Trust Fund
(trust), administered by the Department of Health Care Services
(DHCS), to provide comprehensive primary health care to workers
who do not have health care coverage beyond pregnancy or
emergency care under the federal Patient Protection and
Affordable Care Act (ACA) or Medi-Cal. Specifically, this bill :
1)Establishes the trust to provide comprehensive primary health
care coverage to uncovered workers. Provides that voluntary
contributions may be deposited into the trust from the
following sources:
a) Private donors;
b) Charitable and philanthropic organizations; and,
c) Contributing employers.
2)Requires DHCS, on or before March 1, 2015, to prepare and make
available an application form for nonprofit community health
centers to use in requesting moneys from the trust. Requires
DHCS to include in the application form a memorandum of
understanding that contains space for the following
information, in addition to any data it deems relevant:
a) The name of the contributing employer;
b) The name of uncovered workers that will be employed by
the contributing employer;
c) The length of time that uncovered workers will be
employed by the contributing employers and the time that
those workers will continue to require health care
services; and,
d) The estimated cost of providing health care services to
the contributing employer's uncovered workers.
3)Requires nonprofit community health centers applying for
moneys from the trust to submit an application to DHCS.
4)Provides that moneys from the trust are continuously
appropriated to DHCS and are to be allocated to participating
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nonprofit community health centers no later than July 1, 2015,
unless DHCS determines that the trust has an insufficient
balance to carry out the requirements of this bill, in which
case DHCS may delay implementation until the trust has a
balance of $1 million or more.
5)Requires the Primary, Rural, and Indian Health Division of
DHCS, through the authority of the Rural Health Clinic
Program, to distribute moneys from the trust to nonprofit
community health centers to provide comprehensive primary
health care services, including preventive, mental health and
dental health, to uncovered workers.
6)Requires DHCS to allocate moneys from the trust to nonprofit
community health centers based on the number of uncovered
workers to be served, the length of time the uncovered worker
will be employed by the contributing employers, geographical
location, and any other criteria developed by DHCS in
consultation with contributing employers and nonprofit
community health centers.
7)Requires DHCS to publish a list of nonprofit community health
centers located in the proximity of, and accessible to,
uncovered workers and to provide the list to contributing
employers.
8)Requires nonprofit community health centers to utilize mobile
medical units or provide transportation to uncovered workers
who reside or are employed in geographical areas that make
access to clinic sites difficult.
9)Defines the following terms:
a) Contributing employer is a person who employs an
individual who is ineligible to receive health care
coverage under state or federal programs and contributes
money to the trust;
b) Trust means the Uncovered Worker Health Trust Fund; and,
c) Uncovered worker is an individual who does not have
health care coverage and is ineligible to receive health
care coverage beyond emergency and pregnancy services under
state or federal programs, including, but not limited to,
Medi-Cal or other coverage under the ACA and is working in
the state for an employer who contributes money to the
trust.
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10)Requires the cost to DHCS for administering the trust to be
provided from the trust, not exceed 10% of the total moneys in
the trust.
11)Makes legislative findings and declares that a March 2008
study found that 33.2% of all immigrants did not have health
insurance compared to 12.7% of native-born Americans; the high
level of uninsured amongst the immigrant population means they
often have jobs that do not provide insurance while their low
incomes make private insurance too expensive; that California
is home to almost one-third of all immigrants in the United
States and many of these immigrants are much more likely to
work in small business, agriculture, labor, cleaning or
repair, sales, technology, and administration industries; and,
that based on the annual income earned by many workers in
small business, agriculture, restaurants, sales, and service
industries in California, these workers will not be covered by
the federal ACA and expansion of Medicaid.
EXISTING LAW :
1)Establishes the Medi-Cal program as California's Medicaid
program, administered by DHCS, to provide full-scope health
care coverage for low-income children and adults who are
residents and to qualified immigrants who meet specified
eligibility criteria. Provides limited-scope benefits to
certain low-income pregnant women and immigrants who are not
eligible for full-scope Medi-Cal.
2)Establishes a schedule of benefits under Medi-Cal, which
includes access to federally qualified health center (FQHC)
and rural health center (RHC) clinic services, as defined, as
covered benefits. Requires, under federal law, Medicaid
programs to reimburse FQHCs and RHCs using a Prospective
Payment System (PPS). Requires the PPS to be a minimum
facility-specific, cost-based amount, paid on a per visit
basis and adjusted annually based on a Medicare inflation
factor.
3)Under the ACA, requires individuals to maintain health
insurance or pay a penalty, with exceptions for financial
hardship (if health insurance premiums exceed 8% of household
adjusted gross income), religion, incarceration, and
immigration status and creates the California Health Benefit
Exchange (Exchange), now called Covered California, as an
independent state entity governed by a five-member board, to
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be a marketplace for Californians to purchase affordable,
quality health care coverage, obtain premium assistance and
cost-sharing subsidies, and as a way to meet the personal
responsibility requirements of the ACA.
4)Under the ACA, requires states to extend Medicaid coverage for
parents and caretaker relatives, cover former foster youth up
to age 26, eliminate the asset test for certain groups of
applicants to Medicaid; and, establish a new methodology for
counting income in Medi-Cal, known as Modified Adjusted Gross
Income (MAGI). Requires development of a single, accessible
standardized application for the state subsidy programs to be
used by all eligibility entities.
5)Requires, under federal law, employers to have a completed
form, known as the Form I-9, on file and available for
inspection by authorized U.S. Government officials from the
Department of Homeland Security, Department of Labor, or
Department of Justice for each individual hired. Requires
employers to use the form to verify the identity and
employment authorization of any individual hired, and
employees to attest to his or her eligibility to work.
Requires the employer to examine the employment eligibility
and identity document(s) an employee presents to determine
whether the document(s) reasonably appear to be genuine and
relate to the employee, and to record the document information
on the Form I-9.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
needed to provide an option for employers and employees to
secure some degree of health care coverage for workers that
are not covered by the ACA and Medicaid expansion. According
to a report by the Central Coast Health Network, hundreds of
thousands, potentially as high as one million farm workers in
California will not be covered by the ACA or the Medicaid
expansion. In addition to farm workers, there will be
hundreds of thousands of additional workers in other
industries in California who will remain uninsured or without
access to health care services. According to the author, this
bill provides a viable option for private employers to begin
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the culture of contributing to the health care status of their
employees who contribute to the economic well-being of
California's economy.
According to the author, based on annual income, it is
anticipated that most uncovered workers will be employed in
small business, agriculture, restaurants, sales, and service
industries in California. The author states that about one
quarter of the uninsured will be immigrants, among whom lack
of insurance is a pervasive problem. The author states that
the high rate of uninsured suggests they have jobs that do not
provide insurance while their low incomes make private
insurance too expensive.
2)BACKGROUND . The ACA is the most significant piece of health
policy legislation in over 45 years. One of its main
objectives is to dramatically increase the number of
individuals with health insurance coverage in this country.
By mandating health insurance coverage for all with subsidies
to offset the costs for low-income people; expanding Medicaid
eligibility; establishing virtual market places, known as
health insurance exchanges, to assist individuals and small
employers in purchasing health insurance; allowing young
adults to remain covered under their parents' health insurance
until age 26; and, requiring significant nationwide reforms of
state health insurance markets such as requiring health
insurers to take all comers despite preexisting conditions,
the ACA should lead to the largest expansion of healthcare
coverage since the creation of Medicare and Medicaid in the
1960s. Under the Medicaid expansion, as enacted in
California, nearly 1 million newly enrolled individuals became
eligible for full-scope Medi-Cal in January 2014. An
additional 400,000 individuals signed up for health insurance
through Covered California.
The individual mandate of the ACA requires U.S. citizens and
legal residents to have qualifying health coverage. Those
without coverage pay a tax penalty of the greater of $695 per
year up to a maximum of three times that amount ($2,085) per
family or 2.5% of household income. The penalty will be
phased-in according to the following schedule: $95 in 2014;
$325 in 2015; and, $695 in 2016 for the flat fee or 1.0% of
taxable income in 2014, 2.0% of taxable income in 2015, and
2.5% of taxable income in 2016. Beginning after 2016, the
penalty will be increased annually by the cost-of-living
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adjustment. Exemptions will be granted for financial
hardship, religious objections, American Indians, those
without coverage for less than three months, undocumented
immigrants, incarcerated individuals, those for whom the
lowest cost plan option exceeds 8% of an individual's income,
and those with incomes below the tax filing threshold (in 2009
the threshold for taxpayers under age 65 was $9,350 for
singles and $18,700 for couples).
The ACA assesses employers with an average of 50 or more
full-time employees who do not offer coverage and have at
least one full-time employee who receives subsidies through
the Exchange, a fee of $2,000 per full-time employee,
excluding the first 30 employees from the assessment.
Employers with 50 or more full-time employees that offer
coverage but have at least one full-time employee receiving
the subsidy, will pay the lesser of $3,000 for each employee
receiving a premium credit or $2,000 for each full-time
employee, excluding the first 30 employees from the
assessment. Employers with up to 50 full-time employees are
exempt from the penalties. The ACA requires employers with
more than 200 employees to automatically enroll employees into
health insurance plans offered by the employer. Employees may
opt out of employer coverage. In July 2014, the federal
government announced that enforcement of the employer coverage
mandate would be delayed from 2014 to 2015.
The ACA also provides for coordinated, streamlined enrollment
processes for all the "insurance affordability programs,"
including Medicaid, the Children's Health Insurance Program
(CHIP), cost-sharing and premium subsidy programs provided
through the Exchanges, and optional state-established Basic
Health Plans. With regard to Medicaid, the ACA expanded
eligibility to a new "adult group" and collapsed most existing
eligibility categories into three broad groups: parents;
pregnant women; and, children under age 19. The new "adult
group" includes all non-pregnant individuals ages 19 to 65
with household incomes at or below 133% of the federal poverty
level (FPL). (The ACA includes a five percentage point income
disregard making the effective income limit 138% of the FPL).
As required by the ACA, Medi-Cal financial eligibility for most
groups will be based on MAGI, as defined in the Internal
Revenue Code. Eligibility for the insurance affordability
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programs at the Exchange will begin with a MAGI screen. If an
individual is not found eligible for a MAGI group, the state
must collect necessary information and determine eligibility
under all other Medicaid eligibility categories (i.e.,
MAGI-exempt groups, such as disability) and potential
eligibility for premium assistance and cost-sharing subsidies
through Covered California. States are required, to the
maximum extent possible, to rely on electronic data matches
with trusted third party sources to verify information
provided by applicants. As before the ACA, the Deficit
Reduction Act of 2005 requires all states to collect
documentation verifying citizenship of Medi-Cal applicants and
recipients who are U.S. citizens in order to receive payment
from the federal government for services to these people. The
new streamlined application process will continue to require
states to verify citizenship or qualified immigrant status
through federal data sources.
3)COVERAGE FOR LEGAL IMMIGRANTS . The ACA retains the five-year
waiting period (five year bar) for legal immigrants to enroll
in federal, means-tested benefits like Medi-Cal, originally
enacted as part of federal immigration reform in 1996.
However, all legal immigrants will be able to access coverage
under the Exchange, as well as subsidies and cost-sharing
reductions in the same manner as citizens. Though premium tax
credits and cost sharing reductions are generally only
available for individuals whose income is between 100% and
400% of the FPL, under the ACA legal immigrants with income
under 100% of the FPL who are under the five-year bar have
access to subsidies comparable to other individuals with
income at or over 100% of the FPL. All legal immigrants whose
income is between 133% and 200% of the FPL also would be able
to access Basic Health Plan (BHP) coverage, if the state
chooses to implement the BHP. Though BHP coverage is
generally limited to people over 133% of FPL, the ACA allows
legal immigrants under 133% of the FPL, and who are under the
five-year bar, to access BHP coverage. California has
declined to implement the BHP option.
Under Medi-Cal, California has been providing state-only
full-scope Medi-Cal benefits to low-income qualified
immigrants who have not satisfied the five year bar if they
met the other eligibility criteria, such as parent or
caretaker relative. Immigrants who have permanent residence
under color of law status are also eligible for full-scope
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Medi-Cal. With regard to the new childless adult category, a
"wrap-around program" was authorized as part of the
implementation of the Medi-Cal portions of ACA implementation
in California. This program will allow the newly eligible
adults to enroll in coverage in Covered California with tax
subsidies applied towards their premium. DHCS will provide
payments to reduce the premium and out-of-pocket expenses to
zero. These adults will be eligible for benefits that are
available in the Medi-Cal program, but not included in the
Qualified Health Plan through Covered California. The program
is expected to be implemented no earlier than April 2014. In
the meantime, these qualified immigrants are eligible to
enroll in the state-only Medi-Cal program. Undocumented
immigrants, including childless adults, who are non-citizens
without a lawful immigration status, are eligible for
limited-scope benefits (emergency and pregnancy-related).
4)RESIDUAL UNINSURED AND THE SAFETY NET . According to a report
by the UC Berkeley Center for Labor Research and Education and
the UCLA Center for Health Policy, between 3.1 and 4 million
Californians are predicted to remain uninsured after
implementation of the ACA. Focusing on the under 65
population, the California Simulation of Insurance Markets
model was used to estimate the size and characteristics of
this population The results showed that of the 3.1 to 4
million Californians under 65 that will remain uninsured,
nearly three quarters will be U.S. citizens or lawfully
present immigrants. Approximately 2 million of those who
remain uninsured will be eligible for Medi-Cal or Exchange
subsidies but will remain un-enrolled due to barriers in
enrollment such as challenges in the enrollment process or
lack of awareness about programs. It is anticipated that this
population will continue to rely on the safety net for primary
and episodic care. Generally the safety net is considered to
include community health centers, county clinics, public
hospitals, and community hospitals that serve a
disproportionate share of the uninsured and those with
Medi-Cal. For those who present at safety net hospitals, a
new expedited path to eligibility will be available. This
bill provides a source of funding that applies to low-income
working individuals who are not eligible for Medi-Cal or the
Exchange and is limited to community health centers.
5)COMMUNITY HEALTH CENTERS IN AN ERA OF HEALTH REFORM . FQHCs
and RHCs (also known as community health centers) are
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community-based clinics that provide comprehensive primary
care and preventive care, including health, oral, and mental
health/substance use disorder services to persons of all ages,
regardless of their ability to pay. According to a March 2013
Report by the Kaiser Commission on Medicaid and the Uninsured
(KCMU), Community Health Centers in an Era of Health Reform:
An Overview and Key Challenges to Health Center Growth,
nationally, over 1,100 federally funded community health
centers play a vital role in ensuring access to health care
for a predominantly low-income population in medically
underserved communities. The KCMU report states that health
centers' ability to provide comprehensive primary care and
improve access to high-quality care while holding down health
care cost growth has been well-documented. As health reform
spurs coverage expansion and efforts to improve quality, the
nation's reliance on community health centers is likely to
grow. In the ACA, Congress invested $11 billion over five
years to expand the community health center program, to
broaden access to care in lower-income communities as coverage
expands.
FQHCs receive grants under Section 330 of the federal Public
Health Service Act. Federal certification of FQHCs and RHCs
requires clinics to provide a wide array of preventive and
primary care services in underserved urban or rural
communities. The clinic is also required to provide services
regardless of a patient's ability to pay. Once federally
certified, the clinic is entitled to become a Medi-Cal
provider. According to DHCS, in 2012 there were 681 FQHCs and
293 federally designated RHCs in California. In Fiscal Year
2009-10, FQHCs and RHCs represented over 90% of Medi-Cal
expenditures for clinic-based care. In 2010, 64% of primary
care visits in the doctor's office or clinic setting were at
FQHCs and RHCs.
The KCMU 2013 Report also states that because FQHCs and RHCs are
safety net providers and care for a significant number of the
uninsured, their continued survival depends heavily on the
stability and adequacy of revenues from the Medi-Cal program.
To help preserve this role, under federal law, FQHCs and RHCs
are eligible for enhanced Medicare and Medi-Cal reimbursement.
The enhanced rate helps compensate them for the uncompensated
costs they incur in caring for the uninsured. The rationale
for the enhanced reimbursement is to ensure that FQHCs do not
use federal grant funds, intended for uninsured and special
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needs populations, to back-fill for potentially below-cost
Medicare or Medi-Cal rates. These FQHC and RHC services are
reimbursed in Medi-Cal on a fixed "per visit" rate rather than
by individual services. In California, a number of county-run
clinics have also qualified as FQHCs.
6)STATE AND COUNTY ROLES IN REFORM . Although community health
centers are a significant source of primary health care for
uninsured and low-income individuals in California, counties
are ultimately responsible for providing care to the medically
indigent under what is known as their Section 17000 (Welfare
and Institutions Code) obligation. According to a November
2013 Health Access Foundation Report, counties meet this
obligation in a variety of ways. Twelve counties run public
hospital systems, in most cases accompanied by a network of
county clinics. These typically large and urban counties,
which include Alameda, Contra Costa, Kern, Los Angeles,
Monterey, Riverside, San Bernardino, San Francisco, San
Joaquin, San Mateo, Santa Clara, and Ventura, provide a range
of services, from an emergency room to primary and
preventative services. Another twelve counties, known as
"payer" counties, contract with private health care providers,
such as clinics and community hospitals, to fulfill their
indigent care obligation. These counties are Fresno, Merced,
Orange, Placer, Sacramento, San Diego, San Luis Obispo, Santa
Barbara, Santa Cruz, Stanislaus, Tulare, and until recently,
Yolo. Finally, the remaining 34 small, often rural, counties
belong to the County Medical Service Program (CMSP)
consortium, which offer basic enrollment-based coverage for
those who qualify. Yolo County recently joined CMSP's Low
Income Health Program (LIHP). Funding for these medically
indigent health care services varies from county to county,
but is generally derived from county general funds, sales
taxes, and vehicle license fees. Distribution and expenditure
levels were revised in 1991 in what is known as the 1991
Realignment. The 1991 Realignment consisted of a realignment
of health, human services, and mental health program
obligations and funding between the state and counties.
In 2010, California sought approval of a Section 1115 Medicaid
Demonstration Waiver, entitled "Bridge to Reform" in
preparation for the ACA Medi-Cal expansion that would become
effective in 2014. The demonstration waiver allowed counties
to establish LIHPs to begin enrolling low-income childless
adults who were not previously eligible for Medi-Cal prior to
2014. Through the LIHPs, counties received federal matching
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funds to provide coverage beyond the episodic and emergency
care previously provided and included a medical home with
preventive and primary care, as well as other services. The
LIHPs have been a source of innovation and improvement for the
safety net. Ultimately, 53 of 58 counties chose to set-up
LIHPs and enrolled approximately 630,000 individuals. Most
are in the process of transitioning to Medi-Cal under the
Medi-Cal expansion for childless adults with income under 138%
of FPL. Approximately 24,000 will be eligible for subsidized
coverage through Covered California. This is due to the fact
that some counties used income eligibility levels higher than
138% of FPL.
Implementation of ACA Medi-Cal expansion means the number of
remaining uninsured will be greatly reduced. As a result, the
state sought a reallocation of the 1991 Realignment funding.
For 2013-14, $300 million will return to the state; 2014-15
and thereafter, the share shifted to the state depends on the
formulas chosen by the counties. The agreement gives most
counties a choice of which formula to use, counties can choose
to give back 60% of health realignment dollars (including the
county maintenance of effort contribution) to the state and
retain 40% for public health and indigent care.
Alternatively, counties may choose a formula that is primarily
intended for county-hospital counties based on actual costs,
including costs of care for the uninsured (within a cost cap
based on historical spending to limit any expansions of
service), as well as actual revenue. There is also a formula
that is specific to Los Angeles. Counties will be expected to
provide health care services to the residually uninsured as
well as sustaining its core public health responsibilities.
7)SUPPORT . Clinicas del Camino Real (Clinicas) writes in
support of this bill that it would provide access on a more
permanent basis for farmworkers and workers in the service
industry who will not be eligible or qualify for the ACA or
expansion of Medicaid programs. Clinicas believes this bill
offers a unique, overdue approach for employers who want to
maintain a healthy and productive workforce and would ensure
these workers who are providing a valuable contribution to
California's economy will have vital access to preventive
health care services. The Latino Coalition for a Healthy
California (LCHC) also writes in support, that this bill
represents an innovation of how we approach the difficult
issue of providing health insurance to the residually
uninsured. LCHC argues that approximately 1 million
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Californians will remain uninsured and that two thirds of the
uninsured are expected to be Latino, predominately citizens,
but undocumented as well. LCHC explains with the passage of
immigration reform in 1996, legal permanent residents were
granted resident status but barred from participating in means
tested federal benefits until they have resided in the U.S.
for five years. Since federal funding cannot be used to
provide benefits to this population, undocumented immigrants
are de facto unauthorized for the ACA. LCHC explains that
California's economy and agricultural employers rely on this
population, as does the nation. Yet, many are loathe to
provide even the most basic of health care coverage to those
who provide labor and many times unrequited benefit from their
tax contributions.
8)SUPPORT IN CONCEPT . The California Immigrant Policy Center
(CIPC) writes that it strongly supports the underlying concept
of providing access to health care for undocumented immigrants
across our state. CIPC further states that although many of
California's immigrants and their families stand to benefit
from the ACA, over 1 million uninsured, unauthorized
immigrants are explicitly excluded from buying affordable
health coverage in Covered California and will likely have
fewer options for affordable health care moving forward.
According to CIPC, as the state of California implements the
ACA, policy makers will need to take into account a host of
issues affecting access to care for immigrants. Since
unauthorized immigrants are ineligible for the federally
funded Exchange, Medicaid, CHIP, and Medicare, unauthorized
immigrants are expected to make up one-third of the 3 to 4
million residually uninsured. For this reason, CIPC supports
the idea of creating a trust fund or some other mechanism to
find ways to cover those who have been explicitly excluded
from state and federal health programs post-ACA
implementation. However CIPC lists the following concerns:
a) Under this bill, a contributing employer would have to
essentially admit to hiring undocumented workers; thus
violating federal law under the Immigration Reform and
Control Act. This would likely be a tremendous deterrent
for potential employers who may wish to participate,
preventing the program from having a broad impact for
undocumented community members. CIPC believes there are
ways to overcome these issues by broadening the population
of individuals who could be covered, and by rethinking the
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mechanics and infrastructure of the proposed trust fund.
b) If this bill is assuming there will be federal
immigration reform, by which individuals who adjust their
status from undocumented to provisional status are
restricted from federal and state health programs, there
would be less of a deterrent on potential participating
employers. CIPC, however believes the employer
contributions should be mandatory, and include a state tax
credit or some type of tax deduction, which could be
offered to offset an employer's contributions in the
program and also provide an incentive. CIPC states that a
blended funded mechanism that includes contributions from
all stakeholders, including the worker, employer, and the
state, would be the best way to ensure the financial needs
of a program like this will be sustainable.
c) This bill should also have privacy and confidentiality
protections for the personal information of individuals who
participate in the program to guard against misuse by
others. It is absolutely essential to ensure that this
information cannot be used for immigration enforcement
purposes.
d) CIPC is also interested in finding a way to ensure that
all sectors of workers could benefit. As currently
drafted, it is likely that many individuals like domestic
workers, those who are self-employed, and small business
employees may be left out based on the mechanics of the
current proposal.
9)SUPPORT IF AMENDED . The California Optometric Association
(COA) supports this bill because it would provide health
insurance to those who currently cannot afford it and are not
covered by the ACA and requests that this bill be amended to
include vision care within the benefits. According to COA,
most public and private health plans include vision coverage.
COA also states that vision coverage is important for
correcting vision issues as well as detecting serious health
conditions early such as diabetes, hypertension, and high
cholesterol. In addition, according to COA, vision coverage
for children is essential.
10)RELATED LEGISLATION . AB 880 (Gomez) creates the Employer
Responsibility for Medi-Cal Cost of Employees Act of 2013 that
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requires large employers, employing 500 or more employees, to
pay an employer responsibility penalty, if their employees who
work more than 12 hours per week and more than 45 days in a
calendar year enroll in Medi-Cal based on the MAGI eligibility
standard. Contains an urgency clause in order to become
effective immediately. AB 880 is currently on the Assembly
Inactive File.
11)PREVIOUS LEGISLATION .
a) AB 1 X1, (John A. Pérez), Chapter 3, Statutes of 2013-14
First Extraordinary Session, enacts the statutory changes
necessary to implement the coverage expansion, eligibility,
simplified enrollment, benefits, and retention provisions
of the ACA related to Medi-Cal and California CHIP.
Contains the provisions specifically relating to the
transition of LIHP enrollees to Medi-Cal the workflow
between the California Healthcare Eligibility, Enrollment
and Retention System and county eligibility workers and
Medi-Cal plan selection. Made the enactment contingent
upon enactment of SB 1 X1 (Ed Hernandez).
b) SB 1 X1 (Ed Hernandez and Steinberg), Chapter 4,
Statutes of 2013-14 First Extraordinary Session, enacts the
statutory changes necessary to implement the Medi-Cal in
California and the California CHIP coverage expansion,
eligibility, simplified enrollment, and retention
provisions of the ACA. Contains the provisions of the ACA
relating to benefits, Medi-Cal coverage for former foster
care youth up to age 26, presumptive eligibility
determinations made by qualified hospitals, and coverage
for qualified immigrants. Made enactment contingent upon
enactment of AB 1 X1 (John A. Pérez).
c) AB 85 (Committee on Budget), Chapter 24, Statutes of
2013, establishes county financing mechanisms to determine
county indigent health care savings as a result of the ACA
and makes changes to funding mechanisms governing the 1991
Realignment of health and human services programs, as well
as the funding of California Work Opportunity and
Responsibility to Kids grants.
d) SB 900 (Alquist), Chapter 659, Statutes of 2010,
establishes the Exchange. Requires the Exchange to be
governed by a five-member board, as specified.
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e) AB 1602 (John A. Pérez), Chapter 655, Statutes of 2010,
establishes the Exchange as an independent public entity to
purchase health insurance on behalf of Californians with
incomes of between 100% and 400% FPL and employees of small
businesses. Clarifies the powers and duties of the board
governing the Exchange relative to the administration of
the Exchange, determining eligibility and enrollment in the
Exchange, and arranging for coverage under qualified
carriers.
f) AB 342 (John A. Pérez), Chapter 723, Statutes of 2010,
enacts the LIHP and Coverage Expansion and Enrollment
Projects to provide health care benefits to uninsured
adults up to 200% of the FPL, at county option through a
Medi-Cal waiver demonstration project.
12)POLICY COMMENTS .
a) Identifying Uncovered Employees . As stated above, the
ACA provides coverage through the Medicaid expansion to all
low-income citizens and legal residents not subject to the
five-year bar. As implemented in California, new coverage
options are available for those not subject to the
five-year bar and other authorized immigrant categories.
Under the definition of uncovered employees in this bill,
it appears that only unauthorized immigrants would qualify.
As there are civil and criminal penalties for knowingly
hiring an immigrant not authorized to work, it seems
unlikely that any employer would participate as it would be
admitting employing a person who is not an authorized
resident. Requiring an employer to verify the employee's
ineligibility for an existing program also undermines the
strict privacy protections that are in existing law and
reaffirmed in the ACA. For instance, the ACA prohibits
states from requesting the social security number of a
person in a household who is not applying for coverage.
b) Piecemeal Solution. This bill establishes a mechanism
for funding primary health care services for a specific
sub-sector of the estimated 1 to 2 million individuals who
will be ineligible for coverage under the ACA, as enacted
in California. It is limited to individuals who work for
specific employers willing to contribute to a fund and for
services provided only in community health centers. As
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stated above, many other safety net providers are also
likely to see these individuals and many of the individuals
will be unemployed and may even be children. Furthermore,
community health centers already are receiving supplemental
funding to serve this population whereas, counties will be
losing a significant source of funding that they previously
relied on to provide health care services to this
population. The author may want to explain the policy
rationale for advancing legislation that is so narrowly
crafted instead of a more comprehensive approach.
REGISTERED SUPPORT / OPPOSITION :
Support
California Academy of Family Physicians
California Latino Legislative Caucus
Centro Medico Community Clinic
Clinicas del Camino Real, Inc.
Latino Coalition for a Healthy California
Southern Trinity Health Services
William C. Velásquez Institute
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097