Health Reform Bills Move Through Committee

by David Gorn

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State Senator Ed Hernandez (D-West Covina) had a busy day. At Tuesday's hearing of Assembly Committee on Health, Hernandez had seven different bills heard and approved -- including two of the highest profile health care reform bills in California.

One of them, SB 951, would set the essential health benefits for California under the Affordable Care Act and the other, SB 961, would reform individual coverage in the state.

"Last week the Supreme Court appropriately said the ACA is here to stay," Hernandez said, when introducing the latter bill. "This bill reforms the individual market … to improve access to health coverage in California."

Beth Capell, legislative advocate for Health Access California, had high praise for the individual coverage bill, which includes a provision to eliminate pre-existing conditions as reason to deny coverage.

"No longer can Californians be denied health coverage because of their health status," Capell said. "No longer can their premiums be priced based on their health status. No longer are people locked into their job because they have a pre-existing condition. No longer can entrepreneurs be denied the opportunity to start a business because they need health care coverage. This is a transformative piece of legislation."

The essential benefits bill is similar to AB 1453 (Bill Monning, D-Carmel), which is currently making its way through the Senate.

"SB 951 would set California's essential health benefits based on the Kaiser small group HMO, as the standard plan for essential health benefits," Hernandez said.

The bill promoting individual market coverage changes received little opposition at Tuesday's hearing, while the essential benefits bill raised a number of concerns.

Representatives for the chiropractic industry and advocates for mental health and substance abuse services worried that those services weren't adequately included among the essential benefits.

Concerns also were raised over the word "habilitative," which refers to a type of health service named by federal officials as one of the ACA requirements for inclusion in an essential benefits package.

"It's a relatively new term," said Nick Louizos, director of legislative affairs for the California Association of Health Plans. "In fact, every time I type it into a document, it's flagged as an error, that's how new it is."

Louizos said it's not entirely clear what specific services are included under the habilitative umbrella, both federally and, by extension, in the proposed state law.

"States are required to cover 10 essential benefits," said Monning, who chairs the Assembly Committee on Health. "Habilitative service is one of those 10, and we're in the process of defining what that means."

Assembly member Brian Nestande (R-Palm Desert) asked when that term might be more defined and Monning said that there is "ongoing federal guidance" to be more definitive.


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