Sorting Out Dozens of Health Care Bills -- Some Passed, Some Pending

by David Gorn, California Healthline Sacramento Bureau

Bills never really die in Sacramento -- they just move on to another place

That place is called the legislative committee. That's where legislation ends up, for instance, when the governor lets legislative leaders know a veto is pending. Or when there is support for a bill among a majority of lawmakers, but not among the more powerful ones.

That's where some of the higher-profile health care policymaking efforts have ended up this legislative session.

Most of the Legislature's work this year built up to passage of the budget, which was signed by the governor June 28. The session went into summer recess starting July 3.

The Legislature will reconvene after recess for about a month, from Aug. 5 to Sept. 13. Bills that didn't pass during the main legislative session will return during the shorter autumn period, but that legislation also competes with a flurry of new bills.

What Was Held This Session

Two high-profile legislative movements were held in committee and are in legislative limbo till the fall. 

The first involved an attempt to eliminate all or part of the 10% Medi-Cal provider reimbursement cut the Legislature imposed in 2011. The move had both Democratic and Republican support -- in fact, prior to hitting Appropriations in their house of origin, all of the committee votes were unanimous for AB 900, by Assembly member Luis Alejo (D-Salinas) and SB 640, by Sen. Ricardo Lara (D-Long Beach).

At first, AB 900 only focused on a subset of those providers -- the acute-care, distinct-part skilled nursing facilities -- but it was expanded to include all providers, as SB 640 did. When both measures stalled in Appropriations, Alejo scaled back his Assembly bill to its original intent, just reversing cuts to DP/SNF units. However, even that effort failed.

The state has estimated it will realize $458.8 million general fund savings in fiscal year 2013-2014 from the overall 10% provider cuts imposed two years ago, and another $724.9 million in general fund money for 2014-15.

The second major legislative push of the just-ended session was to expand scope of practice for non-physician practitioners -- physician assistants, nurse practitioners, nurse midwives, optometrists and pharmacists. Those efforts took the form of four different bills, and none of them passed this session; SB 491, SB 492 and SB 493 were all authored by Sen. Ed Hernandez (D-West Covina) and all are still in the Assembly Committee for Business and Professions, while the fourth measure came closest to fruition and is just one floor vote short of passage.

Apparently, the phrase "expanding scope of practice" has become anathema, even though the author of SB 352, Sen. Fran Pavley (D-Agoura Hills), repeatedly said it's not a scope-of-practice bill.

"This is not an expansion of scope of practice, it's an expansion to all kinds of clinic settings," Pavley said. "This bill simply expands the settings for what [medical assistants] are already allowed to do."

The scope of practice would change slightly under the proposed law but not so much for medical assistants. It would allow physician assistants, nurse practitioners and nurse midwives to oversee medical assistants' clinical work when a supervising physician is not in the building.

A bill to regulate the nutritional merits of vending machine food in state buildings failed to reach a floor vote for the second straight session. AB 459, by Assembly member Holly Mitchell (D-Los Angeles), drew its share of snickers in committee hearings, but its purpose was serious -- to improve productivity by offering healthier snack alternatives on state property.

Other bills held until the fall include measures to:

  • Allow medical corporations to directly hire physical therapists;
  • Stop pharmacists from recommending drug alternatives from which they could profit;
  • Use health insurers to create a new fund for primary care residency training; and
  • Expand the number of residency slots in medically underserved areas.

What Passed to the Governor

The big-ticket item this year was the optional Medi-Cal expansion, carried in special session as ABX1-1, by Assembly member John Pérez (D-Los Angeles), and SBX1-1, by Sen. Hernandez.

Under the bills, Medi-Cal would be open to adults with annual incomes up to 138% of federal poverty level, making about 1.4 million Californians newly eligible for Medi-Cal coverage. The two bills also would set up a simplified eligibility system, to facilitate a smoother Medi-Cal enrollment process.

Brown signed the Medi-Cal expansion legislation on June 27.

In April, Brown signed special session bills SBX1-2 (Hernandez) and ABX1-2, by Assembly member Richard Pan (D-Sacramento), making changes to the individual and small group health insurance markets.

And at the tail end of the session, the Legislature passed SBX1-3 by Hernandez, which established a bridge plan worked out by the state's health benefit exchange. The Brown administration already expressed support for the bill, and the governor must sign it by July 30.

"This has been a historic time," Hernandez said. "It is an important moment in our history, where we are passing some of the most sweeping health care policy changes in 50 years. It's just such an exciting time."

The Legislature also sent the governor SB 191, by Sen. Alex Padilla (D-Pacoima), which would extend the sunset date of Maddy emergency department funding until 2021, a source of funding to help compensate counties for treating the uninsured, through fines collected by counties.

David Gorn
This story has been changed to clarify the status of bills still in the legislative process.

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