Health-Related Bills Pass Legislature, Healthy Families in Limbo

by David Gorn

TOPIC ALERT:

The window to save the Healthy Families program is narrowing to a small slit, with just a single day left to pass bills.

Meanwhile, a number of other health-related bills did pass the Legislature yesterday, and are on their way to the governor's desk.

Today -- until midnight tonight -- is the last day for legislation to be passed this year. The governor has until the end of September to veto or approve bills.

There is still a chance that SB 301 by Senate member Mark DeSaulnier (D-Concord) and AB 826 by Assembly member Sandré Swanson -- two identical bills that would reinstate the Healthy Families program and help the state recoup about $184 million from an extended MCO tax -- could pass the Legislature in today's final session of the year, but that prospect is looking less likely now.

At this point, since it still has not been heard in the health committee in either house, let alone made it to the floor for a vote, it would take some kind of deal between the governor and the Legislature leadership to approve the bill. With that kind of deal in place, and bipartisan support for it, as well, it could be possible to waive many of the legislative requirements and get the bill to a floor vote before the midnight deadline.

That would likely happen only if a deal cannot be reached on AB 1469 (Budget Committee), the budget bill that revives the managed care organization tax of $184 million that was lost when Healthy Families was slated for elimination.

It's a bill that requires a two-thirds vote and has had strong Republican opposition. Republicans in both houses said they would not support an extension of the MCO tax unless Healthy Families remains intact.

Among the bills recently passed in the Legislature:

COOPs: The Consumer Operated and Oriented Plan (COOP) bill, AB 1846, by Assembly member Rich Gordon (D-Menlo Park) was sponsored by the Department of Insurance, the agency that would regulate the new type of insurance, similar in structure to agricultural co-ops.

"These COOPs are a help to California consumers," Insurance Commissioner Dave Jones said in a press release, "by returning surplus revenue to members in the form of lower premiums, lower cost-sharing and expanded benefits."

Oral chemotherapy:  AB 1000 by Assembly member Henry Perea (D-Fresno) would require health plans and insurers to cover oral chemotherapy at the same cost as intravenous treatments.

It is not a mandate, said Nicole Evans, vice president of communications at the California Association of Health Plans. "Health plans already cover oral anticancer drugs in addition to infusion treatments," Evans said by email.

She said health plans opposed the bill, not because they disagree with covering oral chemotherapy treatment, but because, she said, "This bill would require the same copayment to apply to both forms of the drug even though these medications are not the same, in terms of their cost or delivery and, in some cases, efficacy." Evans also said that only a small number of oral chemo drugs take the place of IV treatment, but AB 1000 applies to all oral chemo drugs.

Perea said a similar bill has passed twice before (both times vetoed by former Gov. Arnold Schwarzenegger(R). Perea said he hopes it now becomes law under Democratic Gov. Jerry Brown. "Taking your chemo pill at home or at work is a convenient and effective treatment option that should be covered by health insurance plans at a fair price," Perea said. "For some cancer patients, chemo pills are their only hope and there’s no reason they shouldn’t be covered by insurance like IV chemo treatments."

Essential health benefits: SB 951 by Senate member Ed Hernandez (D-West Covina) and AB 1453 by Assembly member Bill Monning (D-Carmel) passed a concurrence vote in separate houses, and are now headed to the governor.

They would set the level of essential health benefits that will be offered by the California Health Benefit Exchange, starting in 2014. The benefits are modeled on the Kaiser Foundation Health Plan small group HMO 30 plan, and include autism, acupuncture and tobacco cessation.

Companion legislation by the same authors, SB 961 and AB 1461, also passed concurrence and are on their way to the governor's desk. Those proposed laws would ban discrimination based on pre-existing conditions.

High risk pool: AB 1526 by Assembly member Bill Monning (D-Carmel) would eliminate annual and lifetime caps in the MRMIP (Major Risk Medical Insurance Pool) program.


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