After a productive year in Sacramento where progress was made on health care, Health Access California released its 2018 Legislative Scorecard. The report details how policymakers voted on key bills to protect patients, expand coverage, and increase oversight on insurers, the health industry, and prescription drug prices. Coming off an election focused on health care, this report highlights who stood with health care consumers over the last legislative session, and shows the key health issues already queued up with strong support as legislators return and look to advance an agenda to bring California closer to universal health care coverage and an affordable, accountable health system.
Despite continued administrative attacks to our health care system from the Trump Administration, California policymakers were successful in protecting California’s coverage gains under the Affordable Care Act (ACA). The Legislature voted to ensure key consumer protections will remain in place, and to take additional steps towards expanding coverage, lowering costs, and improving our health care system.
This year saw the formation of the Care4All California campaign of over 50 health and community organizations dedicated to moving the state closer to 100% health coverage without the need for federal approvals. Almost all of the 20 bills scored were a part of the #Care4AllCA package of bills.
As the statewide health care consumer advocacy coalition, we are proud that nearly half of California State Senators and Assemblymembers voted to stand with health care consumers 100% of the time. California lawmakers passed strong laws to keep key consumer protections in place, to ban the sale of junk insurance, and to increase oversight over insurers, the health industry, prescription drug prices, and more. The Trump Administration continues to find ways to undermine our care, for legal immigrants, for the LGBTQ community, and for us all. California legislators need to remain vigilant in continuing to shield our state from federal sabotage.
While this past legislative session was successful in protecting our progress, California leaders should not be satisfied in just maintaining the status quo, but should take bold next steps. With voters making health care their top concern this election season, our lawmakers must take action to improve and expand our health care system, making it more accessible and affordable to more Californians regardless of age, disability, immigration status, or ability to pay. While many bills to move us towards the goal of universal coverage stalled this session, we appreciated the strong bipartisan support that many got, and we look to the next class of California Senators and Assemblymembers to take the baton and bring us closer to the finish line.
With the votes on twenty bills included, this is our biggest scorecard yet. After this health care election, we expect this will be another very active year on health care legislation, given the urgent need for more Californians to be able to access and afford quality coverage. We will continue to advocate for a robust agenda to attain a universal and accountable health system, scoring votes on our bills so California constituents can know if their legislators are siding with the industry, or with patients and the public interest.
In the 2018 legislative session, health consumers got 100% support from 37 Assemblymembers and 17 Senators. Of those, 13 Senators and 17 Assemblymembers scored 100% two years in a row, or for the full 2017-2018 legislative session. These legislators provided unwavering backing to Health Access California’s sponsored bill and broader agenda for patients and public health—despite opposition by drug companies, doctors, hospitals, health insurers, or other parts of the industry. These 2-year health consumer champions include Senators Allen, Atkins, Beall, Hernandez, Hertzberg, Jackson, Lara, Leyva, McGuire, Mitchell, Monning, Skinner, and Wiener and Assemblymembers Aguilar-Curry, Bonta, Chau, Chu, Friedman, Holden, Jones-Sawyer, Kalra, Levine, Low, Quirk, Rendon, Stone, Thurmond, Ting, Weber, and Wood.
Health bills scored include:
SHIELDING CALIFORNIA CONSUMERS FROM THE FEDERAL SABOTAGE OF OUR HEALTH SYSTEM
- Junk Coverage/Short-Term Plans:
- SB 910 (Hernandez) bans the sale of substandard so-called “short-term” junk insurance plans promoted by the Trump Administration in California.
- Junk Coverage/AHPs: SB 1375 (Hernandez) regulates who can be sold association health plans (AHPs) and requires AHPs to comply with ACA consumer protections.
- Medicaid Work Requirements: SB 1108 (Hernandez) institutes guidelines for Medicaid waivers to prevent eligibility restrictions like work requirements.
- Premium Dollars to Patient Care: AB 2499 (Arambula) ensures health plans spend at least 80% of premium dollars on health care, limiting administrative costs and profits.
ADDRESSING PRESCRIPTION DRUG COSTS
- Prescription Drug Co-Pay Cap: SB 1021 (Wiener) keeps prescription drugs affordable for those with expensive health conditions such as cancer or HIV by maintaining a $250 co-pay cap and improves other protections on access to drugs.
- Cancer Drugs Co-Pay Cap: AB 1860 (Limón) ensures that oral cancer medication stays affordable by stopping health plans and insurers from charging more than $200 per month in out-of-pocket costs for each prescription.
- PBM Transparency: AB 315 (Wood) requires Pharmacy Benefit Managers (PBMs) to register and provide data to the Department of Managed Health Care to help consumers & purchasers benefit from the savings PBMs negotiate.
INCREASING INSURER ACCOUNTABILITY
- Health Plan Mergers: AB 595 (Wood) institutes stronger state oversight over health plan mergers, protecting Californians from negative changes to the health insurance market.
- Public Option Study: AB 2472 (Wood) directs a new California Council on Health Care Delivery Systems to do a feasibility study of a public health insurance option in Covered California and the overall health insurance market.
OTHER PATIENT PROTECTIONS
- Hospital Homeless Patient Discharge Process: SB 1152 (Hernandez) requires hospitals to provide homeless patients a written plan for coordinating services and referrals once they have been discharged, rather than being “dumped” on the street.
EXPANDING ACCESS AND AFFORDABILITY OF COVERAGE
- Health4All (Expanding Medi-Cal Regardless of Immigration Status):
- SB 974 (Lara) was amended to expand Medi-Cal to seniors over age 65.
- AB 2965 (Arambula) was amended to expand Medi-Cal to young adults ages 19-25.
- Affordability Assistance:
- SB 1255 (Hernandez) would have provided additional financial assistance to people whose premiums cost more than 8% of their income.
- AB 2459 (Friedman) would have ensured that Californians earning between 400%-600% FPL spend no more than 8% of their income on health insurance premiums by providing refundable personal income tax credits towards premiums.
- AB 2565 (Chiu) would have provided additional premium assistance to those 400% FPL and below who currently get ACA subsidies.
- AB 3148 (Arambula) would have provided additional cost-sharing assistance to those 400% FPL and below who currently get ACA subsidies.
- Undoing The Senior Penalty in Medi-Cal: AB 2430 (Arambula) would have aligned income-eligibility for the Medi-Cal Aged and Disabled Program with income-eligibility for those under age 65.
- WIC Express Lane Enrollment: AB 2579 (Burke) would have streamlined enrollment into Medi-Calfor those in the WIC program.
ADDITIONAL OVERSIGHT OVER HEALTH INDUSTRY CONSOLIDATION, COST, AND QUALITY
- Health Care Price Relief Act: AB 3087 (Kalra) would have established an independent Health Care Cost, Quality, and Equity Commission to set reasonable base amounts hospitals, doctors, and other providers of health care can collect from payers.
- Ensure Quality in Medi-Cal Managed Care: AB 2275 (Arambula) would have ensured the Medi-Cal managed care plans that cover nearly one-third of Californians are accountable for improving health care quality and reducing disparities.