BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 280
AUTHOR: Lieu and Lara
AMENDED: January 6, 2014
HEARING DATE: January 15, 2014
CONSULTANT: Bain
SUBJECT : Insurance affordability programs: application form.
SUMMARY : Permits, until January 1, 2015, the application form
for insurance affordability program coverage to include
additional voluntary questions on sexual orientation and gender
identity or expression. Requires, effective January 1, 2016, the
application form to include voluntary questions regarding
demographic data categories, including race, ethnicity, primary
language, disability status, sexual orientation, gender identity
or expression and other categories recognized by the federal
Secretary of the Department of Health and Human Services.
Existing law:
1.Requires a single, accessible, standardized paper, electronic,
and telephone application for insurance affordability programs
to be developed by the Department of Health Care Services,
(DHCS) in consultation with the Managed Risk Medical Insurance
Board (MRMIB) and the board governing Covered California (the
state's health benefit exchange). Requires the application
form to be used by all entities authorized to make an
eligibility determination for any of the insurance
affordability programs and by their agents.
2.Defines "insurance affordability programs" as the Medi-Cal
program, the state's children's health insurance program
(CHIP, formerly the Healthy Families Program in California),
and coverage through a qualified health plan in Covered
California with an advance premium tax credit or cost-sharing
reduction established under federal law.
3.Authorizes the application form to include voluntary questions
regarding demographic data categories, including race,
ethnicity, primary language, disability status, and other
categories recognized by the federal Secretary of the
Department of Health and Human Services (DHHS) pursuant to
federal law.
Continued---
SB 280 | Page 2
This bill:
1.Authorizes, until January 1, 2015, the application form for
insurance affordability program coverage to include additional
voluntary questions on sexual orientation and gender identity
or expression.
2.Requires, effective January 1, 2016, the application form to
include questions that are voluntary for applicants to answer
regarding demographic data categories, including race,
ethnicity, primary language, disability status, sexual
orientation, gender identity or expression and other
categories recognized by the federal Secretary of the DHHS.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, there is currently an
insufficient amount of data being collected on the lesbian, gay,
bi-sexual and transgender (LGBT) demographic, which makes it
difficult to accurately and appropriately address the health
disparities of the LGBT population within California. With the
Affordable Care Act (ACA) in place, this bill would create another
opportunity for Covered California and the DHCS to attempt to
collect this data voluntarily provided by applicants.
2.Background. The ACA makes numerous changes to simplify enrollment
in public health coverage
programs. The ACA requires that an enrollment system be created that
allows state residents to apply for enrollment, receive an
eligibility determination, and renew participation in state health
subsidy programs. In addition, ACA requires the Secretary of DHHS
to develop and provide to each state a single, streamlined
application form that may be used to apply for all applicable
state health subsidy programs (Medi-Cal, Healthy Families Program,
and Covered California), which may be filed online, in person, by
mail, or by telephone.
States were also allowed to develop and use their own single,
streamlined application form if it was consistent with federal
standards. California developed its own joint application for
state health subsidy programs. The current paper joint application
for insurance affordability programs asks applicants:
� Whether the applicant is male or female;
� Whether the applicant has a physical, mental, emotional
SB 280 | Page
3
or developmental disability; and,
� In what language should the state write and speak to the
individual who is the main contact on the application.
In addition, the joint paper application asks applicants for
their race and indicates providing this information is
optional. It also asks if an individual is of Hispanic, Latino
or Spanish origin and asks about country of origin. The
current joint application does not ask for information about
sexual orientation or gender identity or expression. Data from
Covered California for the months of October and November 2013
indicates 77.2 percent of enrollment provided information
about their race.
1.Prior legislation. AB 1208 (Pan) of 2013 contained provisions
similar to this bill. AB 1208 was vetoed by the Governor, who
stated the state does not need to mandate these requirements
in law as DHCS and Covered California already have the
authority to modify these types of questions on the form, and
they can work constructively with stakeholders to decide what
is necessary to change for 2015 and beyond.
2.Support. This bill is sponsored by Equality California (EC),
which states a number of studies have indicated that members
of the LGBT population continue to experience worse health
outcomes than their non-LGBT counterparts. Due to factors like
low rates of health insurance coverage, high rates of stress
from systematic harassment and discrimination, and a lack of
cultural competency in the health care system, LGBT people are
at a higher risk for cancer, mental illnesses, and other
diseases, and are more likely to smoke, drink alcohol, use
drugs, and engage in other risky behaviors. EC states it can
only estimate the full extent of LGBT health disparities due
to a lack of consistent data collection on sexual orientation
and gender identity. EC argues this bill will significantly
help to address this problem by requiring that data on sexual
orientation and gender identity that is voluntarily given be
collected for the purposes of various health insurance
programs in the state. This information will allow researchers
and advocates to get a fuller and more accurate accounting of
LGBT health outcomes and needs-and ultimately to close the gap
between the health and well-being of LGBT people and the
non-LGBT population.
The California Pan-Ethnic Health Network writes in support that
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health disparities are prevalent, and the state's health care
programs must improve the way they collect and analyze data by
enrollee demographic, including race, ethnicity, language and
sexual orientation.
SUPPORT AND OPPOSITION :
Support: Equality California (sponsor)
California Pan Ethnic Health Network
L.A. Gay & Lesbian Center
Western Center on Law and Poverty
Oppose: None received
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