BILL ANALYSIS �
AB 2301
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Date of Hearing: April 22, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2301 (Mansoor) - As Amended: March 28, 2014
SUBJECT : California Health Benefit Exchange: reports.
SUMMARY : Requires the California Health Benefit Exchange
(Exchange, now known as Covered California) to prepare a
quarterly report that provides statistics on the number of
people covered under individual health plans purchased through
the Exchange. Specifically, this bill :
1)Requires the report to include data on covered individuals by
total number covered, age, ethnicity, gender, income level,
and geographic region.
2)Requires the report to identify the number of individuals who
disenrolled from a health plan due to nonpayment of premiums.
3)Requires the report to be completed within 30 days of the end
of the quarter, transmitted to the Legislature and the
Governor, and published on the Exchange's Website.
EXISTING LAW :
1)Establishes the Exchange as an independent entity in state
government. Requires the Exchange to compare and make
available through selective contracting health insurance for
individual and small business purchasers as authorized under
the federal Patient Protection and Affordable Care Act (ACA).
2)Under federal law, establishes requirements for health plans
offered through state exchanges, including that the plan
provides essential health benefits and follows established
limits on cost-sharing (deductibles, copayments, and
out-of-pocket maximum amounts). Under federal law, creates
five tiers, or metal levels, of coverage for health plans
offered through the Exchange, catastrophic, bronze, silver,
gold, and platinum, based on the plan's actuarial value, or
the amount of health care costs a typical individual would be
responsible for paying.
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3)Under federal law, allows an individual with income under 400%
of the federal poverty level, provided certain conditions are
met, to receive a subsidy in the form of a refundable tax
credit toward the purchase of an Exchange plan.
4)Requires each health plan that participates in the Exchange to
offer in the Exchange at least one product within each of the
five metal levels of coverage and allows the Exchange to
standardize products sold through the Exchange.
5)Requires health plans and insurance policies to be offered on
a guaranteed issue basis and requires health plans and
insurers in the individual market to set premium rates based
only on age, family status, and geographic region. Creates 19
geographic pricing regions in the state.
6)Establishes the Exchange SHOP (Small Business Health Options
Program), separate from activities of the Exchange Board
related to the individual market, to assist qualified small
employers with the enrollment of their employees in qualified
health plans (QHPs) offered through the Exchange in the small
employer market in a manner consistent with the ACA.
7)Requires the Exchange to annually prepare a report on the
implementation and performance of the Exchange functions,
including: the manner in which funds were expended and the
progress toward, and the achievement of, the Exchange's
statutory requirements.
8)Requires the Exchange to require QHPs, as a condition of
participation in the Exchange, to make available to the public
and submit to the Exchange, the U.S. Secretary of Health and
Human Services, and the Insurance Commissioner or the
Department of Managed Health Care, as applicable, accurate and
timely disclosure of the specified information, including data
on enrollment and data on disenrollment.
9)Requires the Department of Health Care Services (DHCS), in
collaboration with the Exchange, the counties, consumer
advocates, and the Statewide Automated Welfare System
consortia, to prepare quarterly reports to the California
Health and Human Services Agency, the Exchange, and the
Legislature, about the enrollment process for all insurance
affordability programs, including Medi-Cal and subsidized
coverage under a QHP selected through the Exchange. Among
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numerous data points, requires these reports to include:
a) The number of applications received;
b) Applicant demographics, including, but not limited to,
gender, age, race, ethnicity, and primary language;
c) The disposition of applications, including the number of
eligibility determinations that resulted in an approval or
a denial for coverage;
d) The number of days for eligibility determinations to be
completed;
e) The health plans that are selected by applicants;
f) The number of beneficiary disenrollments, the reasons
for the disenrollments, and how many people switched from
one insurance affordability program to another;
g) The number of applications for insurance affordability
programs that were filed with the help of an assister or
navigator; and,
h) The total number of grievances and appeals filed by
applicants and enrollees.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author of this bill,
given the magnitude of the Exchange and the significant
expenditure of taxpayer funds, it is vital that all aspects of
the program be available for public review. In order to
examine the success of the program and its impact on the
uninsured in California, it is important to examine those who
have enrolled in health insurance coverage by age, ethnicity,
gender, income level, and geographic region in California.
The author asserts that it is also important to examine those
who have disenrolled from coverage, the reasons why they
disenrolled, and whether there are any barriers that are
inherent to the Exchange. The author writes that the
reporting requirement created by this bill is consistent with
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the monthly reports that were produced in evaluating the
successful Healthy Families Program, which provided health,
dental, and vision coverage for the children of lower income
working Californians.
2)BACKGROUND . Covered California currently provides detailed
enrollment statistics every month. The most recent detailed
statistics, released March 13, 2014, include data on
enrollment for the period from October 1, 2013, through
February 28, 2014. To date, 880,000 individuals had enrolled
in coverage, and Covered California indicated that insurance
companies reported 85% of enrollees had paid their first
month's premium (Covered California subsequently reported
that, through the end of March, total enrollment reached more
than 1.2 million). Data on enrollments for this period were
reported by age, race, language, metal level, carrier
selected, and pricing region. This data was cross tabulated
by individuals eligible for a federal premium subsidy and
individuals ineligible for a subsidy. In addition, data were
reported for each of the 19 pricing regions, broken down by
metal level and by issuer, also cross tabulated by subsidy
eligibility.
3)RELATED LEGISLATION .
a) AB 1560 (Gorell) prohibits the Exchange from disclosing
an individual's personal information to third parties for
the purpose of eligibility or enrollment in health care
coverage unless the individual confirms specified
information and provides prior written consent. AB 1560 is
pending in this Committee and is set to be heard April 22,
2014.
b) AB 1829 (Conway) prohibits the Exchange from hiring or
contracting with a person who has been convicted of
specified crimes if the person would be facilitating
enrollment or have access to enrollees' financial or
medical information. AB 1829 is pending in this Committee
and is set to be heard April 22, 2014.
c) AB 1830 (Conway) prohibits the Exchange and its
employees from using or disclosing personal information
except as necessary to carry out specified functions under
the ACA and creates a civil penalty of up to $25,000 per
individual or entity, per use or disclosure. AB 1830 is
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pending in this Committee and is set to be heard April 22,
2014.
d) AB 2601 (Conway) prohibits the Exchange from assessing
or increasing a charge on health plans, on or after January
1, 2016, unless the charge is enacted as a statute. AB
2601 is pending in this Committee and is set to be heard
April 22, 2014.
e) SB 20 (Ed Hernandez) makes several changes to reporting
requirements for the Exchange and for health plans and
insurers, including requiring the Exchange to report
enrollment data annually that includes the total number of
enrollees, the percentage of enrollees receiving a federal
subsidy, the percentage of enrollees in each metal tier of
coverage, and the age, race, and ethnicity of the
enrollees. SB 20 is pending in the Assembly Committee on
Rules.
f) SB 332 (Emmerson and DeSaulnier), Chapter 446, Statutes
of 2013, eliminates an exemption from the Public Records
Act (PRA) for contracts entered into by the Exchange and
instead requires contracts between health plans or insurers
and the Exchange be open to inspection one year after the
effective date and payment rates be open three years after
a contract or amendment is open to inspection. Also
deletes a provision which exempts impressions, opinions,
strategy, training, and other Exchange business from the
PRA.
g) SB 974 (Anderson) prohibits the Exchange from disclosing
an individual's personal information to any other person or
entity without explicit permission and requires the
Exchange to report a disclosure in violation of this
provision within five business days. SB 974 is pending in
the Senate Appropriations Committee.
h) SB 1052 (Torres) requires health plans offered in the
Exchange to post a current formulary for the plan on their
Websites, requires the Exchange to provide a direct link to
the posted formularies, and requires the Exchange to
provide a Web search tool that allows searching by drug or
by therapeutic condition. SB 1052 is pending in the Senate
Health Committee.
4)PREVIOUS LEGISLATION .
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a) AB 1 (John A. P�rez), Chapter 3, Statutes of 2013-14
First Extraordinary Session, implements Medi-Cal coverage
expansion, eligibility, simplified enrollment benefits, and
retention provisions of the ACA, including requiring DHCS
to provide quarterly reports on enrollment in all insurance
affordability programs.
b) AB 1602 (John A. P�rez), Chapter 655, Statutes of 2010,
and SB 900 (Alquist), Chapter 659, Statutes of 2010,
establish the Exchange and its powers and duties.
5)POLICY COMMENTS .
a) This bill requires the Exchange to report age,
ethnicity, gender, income level, and geographic region.
Current monthly enrollment reports released by the Exchange
also report race, language, metal level, and carrier
selected. The Committee may wish to amend this bill to
require the Exchange's quarterly reports to include at
least these data.
b) This bill requires the Exchange to report on quarterly
disenrollments due to nonpayment of premiums, but does not
require reporting on disenrollments for other reasons. The
Committee may wish to amend this bill to require the
Exchange to report on all disenrollments and the reasons
for disenrollment.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
None on file.
Analysis Prepared by : Ben Russell / HEALTH / (916) 319-2097