BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1053|
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UNFINISHED BUSINESS
Bill No: SB 1053
Author: Mitchell (D)
Amended: 8/18/14
Vote: 21
SENATE HEALTH COMMITTEE : 6-1, 4/30/14
AYES: Hernandez, De Le�n, DeSaulnier, Evans, Monning, Wolk
NOES: Morrell
NO VOTE RECORDED: Beall, Nielsen
SENATE APPROPRIATIONS COMMITTEE : 5-2, 5/23/14
AYES: De Le�n, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
SENATE FLOOR : 25-11, 5/29/14
AYES: Beall, Block, Corbett, Correa, De Le�n, DeSaulnier, Evans,
Galgiani, Hancock, Hernandez, Hill, Hueso, Jackson, Lara,
Leno, Lieu, Liu, Mitchell, Monning, Padilla, Pavley, Roth,
Steinberg, Torres, Wolk
NOES: Anderson, Berryhill, Cannella, Gaines, Huff, Knight,
Morrell, Nielsen, Vidak, Walters, Wyland
NO VOTE RECORDED: Calderon, Fuller, Wright, Yee
ASSEMBLY FLOOR : 54-22, 8/20/14 - See last page for vote
SUBJECT : Health care coverage: contraceptives
SOURCE : California Family Health Council
National Health Law Program
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DIGEST : This bill requires, effective January 1, 2016, most
health plans and insurers to cover a variety of Food and Drug
Administration (FDA)-approved contraceptive drugs, devices, and
products for women, as well as related counseling and follow-up
services and voluntary sterilization procedures. Prohibits
cost-sharing, restrictions, or delays in the provision of
covered services, but allows cost-sharing and utilization
management procedures if a therapeutic equivalent drug or device
is offered by the plan with no cost-sharing.
Assembly Amendments 1) authorize cost-sharing for equivalent
non-preferred drugs, devices, products unless, the enrollee is a
Medi-Cal beneficiary; 2) include Medi-Cal managed plans in the
definition of a health care service plan; 3) require utilization
controls for family planning services for Medi-Cal managed care
plans to be subject to cost-sharing requirements; and 4) make
other, technical changes.
ANALYSIS : Existing law:
1. Regulates health plans through the Department of Managed
Health Care (DMHC) and health insurance policies through the
Department of Insurance (CDI).
2. Requires group and individual health plan contracts or
health insurance policies, except specialized plans or
policies, that are issued, amended, renewed, or delivered on
or after January 1, 2000, to provide coverage for a variety
of federal FDA-approved prescription contraceptive methods
designated by the plan, if the plan or policy provides
coverage for outpatient prescription drug benefits.
3. Requires, if the patient's provider determines that none of
the methods designated by the plan or insured is medically
appropriate, the plan or insurer to also provide coverage for
another FDA-approved medically appropriate prescription
contraceptive method prescribed by the patient's provider.
4. Requires outpatient prescription benefits for an enrollee or
insured to be the same for an enrollee's or insured's covered
spouse and non-spouse dependents.
5. Prohibits anything in the law from being construed to
exclude coverage for prescription contraceptive supplies
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ordered by a health care provider with prescriptive
authority, for reasons other than contraceptive purposes,
such as decreasing the risk of ovarian cancer or eliminating
symptoms of menopause, or for prescription contraception that
is necessary to preserve the life or health of an enrollee or
insured.
6. Prohibits anything in the law from being construed to deny
or restrict in any way DMHC's or CDI's authority to ensure
plan compliance with the law when a plan or insurer provides
coverage for prescription drugs.
7. Requires #2 to apply to disability insurance policies that
are defined as health benefit plans, as specified, except
that for accident only, specified disease, or hospital
indemnity coverage, coverage for benefits under #2 apply to
the extent benefits are covered under the general terms and
conditions that apply of all other benefits under the policy.
Prohibits anything in the law from being construed as
imposing a new benefit mandate on accident only, specified
disease, or hospital indemnity insurance.
8. Authorizes a religious employer to request a health plan
contract or insurance policy without coverage for
FDA-approved contraceptive methods that are contrary to the
religious employer's religious tenets, as specified.
This bill:
1.Requires a health care service plan contract or health
insurance policy issued, amended, or renewed on or after
January 1, 2016, to provide coverage for women for all
prescribed and FDA-approved female contraceptive drugs,
devices, and products, as well as voluntary sterilization
procedures, contraceptive education and counseling, and
related follow-up services.
2.Prohibits a nongrandfathered plan contract or health insurance
policy from imposing any cost-sharing requirements or other
restrictions or delays with respect to this coverage, as
specified.
3.Includes Medi-Cal managed plans, as specified, in the
definition of a health care service plan.
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4.Retains the provision authorizing a religious employer to
request a contract or policy without coverage of FDA-approved
contraceptive methods that are contrary to the employer's
religious tenets.
5.Requires utilization controls for family planning services for
Medi-Cal managed care plans to be subject to cost-sharing
requirements, as described.
Comments
Essential health benefits (EHBs) and state benefit mandates .
Effective January 1, 2014, federal law requires Medicaid
benchmark and benchmark equivalent plans, plans sold through
Covered California, and carriers providing coverage to
individuals and small employers to ensure coverage of EHBs, as
defined by the Secretary of the Department of Health and Human
Services. The Department of Health and Human Services is
required to ensure that the scope of EHBs is equal to the scope
of benefits provided under a typical employer plan, as
determined by the Secretary.
SB 951 (Hernandez, Chapter 866 Statutes of 2012), and AB 1453
(Monning, Chapter 854, Statutes of 2012), designate the Kaiser
Small Group health plan to serve as California's EHB benchmark
plan.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Assembly Appropriations Committee:
1.According to the California Health Benefits Review Program,
annual fiscal impact in the private insurance market as
follows:
A. $65 million in increased premiums for private health
care coverage statewide, including:
$37 million in premium costs to private employers.
$26 million in premium costs to individuals.
$2 million in premium costs to CalPERS.
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A. $216 million in cost savings due to averted deliveries
and abortion services. Assuming these costs savings are
proportionate to increased expenditures:
$123 million in savings to private employers.
$86 million in savings to individuals.
$7 million in savings to CalPERS.
1.Estimated Medi-Cal managed care costs of $10 million (10%
General Fund (GF)/90% federal), and projected cost savings of
$56 million (about 45% GF/55% federal) annually after
implementation due to an estimated 6,000 additional
pregnancies averted.
2.Estimated potential increased state costs exceeding $5 million
to pay the costs of this contraceptive coverage on behalf of
enrollees in Covered California.
3.Costs to DMHC of $300,000 to verify compliance and clarify
coverage requirements via regulation (Managed Care Fund).
Ongoing costs should be minor, in the range of $50,000
annually (Managed Care Fund).
4.Minor ongoing costs to CDI to oversee compliance, in the range
of $50,000 annually (Insurance Fund).
5.Cost savings are likely to accrue to state and local
governments in a variety of health, social services, and
education programs, including Medi-Cal, due to reduced demand
for these services as a result of over 20,000 fewer unintended
pregnancies statewide. About half of pregnancies end in
delivery. These cost savings are beyond the scope of this
analysis but will be cumulative and are likely to be
significant.
SUPPORT : (Verified 5/28/14)(Unable to reverify at time of
writing)
California Family Health Council (co-source)
National Health Law Program (co-source)
American Association of University Women - California
American Civil Liberties Union of California
American Congress of Obstetricians and Gynecologists, District
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American Federation of State, County and Municipal Employees,
AFL-CIO
California Academy of Family Physicians
California Communities United Institute
California Latinas for Reproductive Justice
California Nurse Midwives Association
California Primary Care Association
California School Employees Association
California School-Based Health Alliance
Center on Reproductive Rights and Justice at UC Berkeley School
of Law
Los Angeles Trust for Children's Health
NARAL Pro-Choice California
National Council of Jewish Women-California
National Health Law Program
Physicians for Reproductive Health
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood of Orange and San Bernardino Counties
Planned Parenthood of Santa Barbara, Ventura & San Luis Obispo
Counties, Inc.
Planned Parenthood of the Pacific Southwest
Planned Parenthood Pasadena and San Gabriel Valley
Six Rivers Planned Parenthood
Women's Foundation
OPPOSITION : (Verified 5/28/14)(Unable to reverify at time of
writing)
Alliance of Catholic Health Care
Association of California Life and Health Insurance Companies
California Association of Health Plans
California Catholic Conference
California Chamber of Commerce
California Right to Life Committee, Inc.
Molina Healthcare of California
ARGUMENTS IN SUPPORT : The National Health Law Program states
that this bill builds on current California and federal law to
improve access to a full range of contraceptive methods for
women and men, and to ensure that every individual has access to
their choice of contraception without barriers, delays, or
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cost-sharing. A number of Planned Parenthood affiliates write
that the Affordable Care Act (ACA) includes a women's preventive
care provision that requires most health insurance carriers to
provide the full range of FDA-approved birth control methods
without any out-of-pocket costs, however a lack of clarity in
federal regulations has led to inadequate and inconsistent
implementation of this law. The Los Angeles Trust for
Children's Health, National Council of Jewish Women-California,
Physicians for Reproductive Health, California Latinas for
Reproductive Justice, California School-Based Health Alliance,
and American Civil Liberties Union of California states that
lack of clarity in the law has led to inadequate and
inconsistent implementation, allowing carriers to employ varying
medical management techniques and practices that create barriers
to access. Supporters state that these practices include
requiring a woman to try a different method before she can get
coverage for her method of choice, wrongfully charging co-pays,
and denials of certain methods. California Nurse-Midwives
Association states that reproductive management needs to remain
between the health care provider and the women based upon her
individual needs according to her history and physical findings
and should be afforded a full range of reproductive choices.
American Association of University Women, California states that
the full access to all contraceptives afforded by this bill will
yield better compliance and better results, allowing women to be
able to lead their lives according to their own reproductive
life plan.
ARGUMENTS IN OPPOSITION : The California Catholic Conference
states that the "barriers" referenced by the author are not
unique to contraceptives, but familiar to any patient with
insurance and it is important to remember that some barriers
exist in order to protect the health of the user. The Alliance
of Catholic Healthcare stares that this bill contains mandates
that are different than the federal mandate, including in the
definition of religious employer, no accommodation for
non-profit religious organizations, and expanded coverage for
contraceptives. The Association of California Life and Health
Insurance Companies cites CHBRP cost estimates of this bill and
states that they generally oppose all benefit mandates because,
while they sympathize with the intent, mandates increase the
already high cost of care for everyone and eliminate the
flexibility an employer would otherwise have to pick benefits
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that best address the needs of his/her employees. The
California Association of Health Plans states that this bill
increases premiums and likely conflicts with federal guidelines.
The California Chamber of Commerce asserts that employers are
already facing tough choices about how best to fulfill their
responsibilities under the ACA and absorb many new health care
cost pressures, and this is the wrong time to add to that burden
a new mandate.
ASSEMBLY FLOOR : 54-22, 8/20/14
AYES: Alejo, Ammiano, Bloom, Bocanegra, Bonilla, Bonta,
Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau,
Chesbro, Cooley, Dababneh, Daly, Dickinson, Eggman, Fong,
Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray, Hall,
Roger Hern�ndez, Holden, Jones-Sawyer, Levine, Lowenthal,
Medina, Mullin, Muratsuchi, Nazarian, Pan, Perea, John A.
P�rez, V. Manuel P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Weber,
Wieckowski, Williams, Yamada, Atkins
NOES: Bigelow, Ch�vez, Conway, Dahle, Donnelly, Fox, Beth
Gaines, Gorell, Hagman, Harkey, Jones, Linder, Logue,
Maienschein, Mansoor, Melendez, Nestande, Olsen, Patterson,
Wagner, Waldron, Wilk
NO VOTE RECORDED: Achadjian, Allen, Grove, Vacancy
JL:nl 8/20/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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