BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 1182|
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UNFINISHED BUSINESS
Bill No: SB 1182
Author: Leno (D)
Amended: 8/27/14
Vote: 21
SENATE HEALTH COMMITTEE : 7-1, 4/24/14
AYES: Hernandez, Beall, De Le�n, DeSaulnier, Evans, Monning,
Wolk
NOES: Morrell
NO VOTE RECORDED: Nielsen
SENATE APPROPRIATIONS COMMITTEE : 5-2, 5/23/14
AYES: De Le�n, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
SENATE FLOOR : 21-12, 5/28/14
AYES: Beall, Block, Corbett, De Le�n, DeSaulnier, Evans,
Galgiani, Hancock, Hernandez, Hill, Hueso, Jackson, Leno,
Lieu, Liu, Mitchell, Monning, Padilla, Pavley, Steinberg, Wolk
NOES: Anderson, Berryhill, Correa, Fuller, Gaines, Huff,
Knight, Morrell, Nielsen, Vidak, Walters, Wyland
NO VOTE RECORDED: Calderon, Cannella, Lara, Roth, Torres,
Wright, Yee
ASSEMBLY FLOOR : Not available
SUBJECT : Health care coverage: claims data
SOURCE : California Labor Federation
Teamsters
UNITE HERE
CONTINUED
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DIGEST : This bill requires health plans and insurers to share
specified data with purchasers that have 1,000 or more enrollees
or that are multiemployer trusts.
Assembly Amendments revise and recast the provisions of this
bill by deleting provisions requiring health plans and insurers
to submit to regulators for rate review of any large group plan
contract or policy rate increases that exceed 5% of the prior
year's rate and instead require a health care service plan or
health insurer to provide deidentified claims data to a large
group purchaser that requests the information and meets
specified conditions, as specified.
ANALYSIS :
This bill:
1. Requires a health plan or insurer annually to provide
deidentified claims data at no charge to a large group
purchaser upon request, if the purchaser is able to
demonstrate its ability to comply with state and federal
privacy laws and is either an employer with enrollment of
greater than 1,000 covered lives (at least 500 of which are
enrolled with the health plan or insurer) or a multiemployer
trust with enrollment of greater than 500 lives (at least 250
of which are enrolled with the health plan or insurer).
Requires health plans and insurers to obtain a determination
by a qualified statistician that the claims data do not
provide a reasonable basis from which to identify an
individual. Allows a health plan to provide the claims data
in an aggregated form as necessary to comply with state and
federal privacy laws.
2. As an alternative to providing claims data under #1) above,
requires a health plan or insurer to provide: deidentified
aggregated data sufficient for the purchaser to compare costs
of similar services from other health plans or insurers; and
deidentified aggregated patient level data that includes
demographics and encounter data, including data used to
experience rate the group, as specified. Requires the health
plan or insurer, for purposes of this requirement, to obtain
a formal determination, documented in writing, from a
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qualified statistician that the shared data do not provide a
reasonable basis from which to identify an individual.
3. Provides that data that a statistician is unable to determine
has been deidentified shall not be shared under this bill.
4. Makes the information shared not subject to public
availability, as specified. Deems data shared under this
bill confidential information that shall not be shared by
state regulators and is exempt from disclosure under the
California Public Records Act. Prohibits health plans and
insurers from disclosing their contracted rates with
providers to purchasers under this bill.
Comments
The author's office states that the rising cost of health care
is a major concern for employers in California, and the lack of
transparency in pricing for the large group market has
contributed to uncontrolled cost increases for large employers
and union trusts. This bill is intended to bring transparency
to this market for purchasers in an effort to control costs.
According to the Medical Expenditure Panel Survey (MEPS), a
survey of employers conducted by the United States Census Bureau
that collects information on employer-sponsored health
insurance, premiums for employer-based coverage have increased
significantly over the past decade. MEPS data from 2012 show
the average annual premium for individual private sector
employer coverage in California is $5,422, an 85% increase since
2002. For family coverage, the average premium was $15,898, a
90% increase since 2002. For comparison, prices for goods and
services increased 27.6% during this period, according to the
Bureau of Labor Statistics' Consumer Price Index.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Assembly Appropriations Committee:
Enforcement costs of $350,000 for the first two years, and
$100,000 ongoing, to address complaints and staff trials
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regarding alleged violations to the Department of Managed
Health Care (Managed Care Fund).
Enforcement costs to the California Department of Insurance
are likely to be minor and absorbable (Insurance Fund).
Unknown cost pressure to the California Public Employees'
Retirement System, potentially exceeding $100,000, for the
provision of health benefits, assuming costs of compliance
are passed on to large-group customers in the form of a
general increase in administrative costs (General
Fund/federal/special/local).
SUPPORT : (Verified 8/29/14)
California Labor Federation (co-source)
Teamsters (co-source)
UNITE HERE (co-source)
AFSCME
California Alliance of Retired Americans
California Conference Board of the Amalgamated Transit Union
California Conference of Machinists
California Department of Insurance
California-Nevada Conference of Operating Engineers
California Nurses Association
California Physical Therapy Association
California Professional Firefighters
California Retired Teachers Association
California School Employees Association
California Teachers Association
California Teamsters Public Affairs Council
CALPIRG
City and County of San Francisco
Communication Workers of America, District 9, AFL-CIO
Congress of California Seniors
Engineers and Scientists of CA, IFPTE Local 20, AFL-CIO
Federated Indians of Graton Rancheria
Health Access
Health Care for All California
International Longshore and Warehouse Union
Professional and Technical Engineers, IFPTE Local 21, AFL-CIO
Sailors' Union of the Pacific
San Diego Electrical Health and Welfare Trust
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SEIU California
State Building and Construction Trades Council
United Auburn Indian Community
Utility Workers Union of America, Local 132
Yocha Dehe Wintun Nation
ARGUMENTS IN SUPPORT : The California Labor Federation (Labor
Fed), a co-sponsor of this bill, writes that rising health care
costs are taking a toll on employers, workers, and union trust
funds. The Labor Fed argues every dollar that large purchasers
have to put toward health coverage is a dollar that comes out of
workers' pockets, with employers increasingly shifting costs to
workers by increasing cost sharing and the use of
high-deductible plans. The Labor Fed argues that this bill's
requirement for health plans to disclose claims data to large
purchasers will help those purchasers understand health care
cost drivers, institute cost savings programs, and bargain
effectively with health plans. The California Teachers
Association, in support, argues the data provided under this
bill will be an essential tool in the bargaining process, one
that has the potential to free up funds for use in the
classroom.
JL:d 8/29/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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