Some Good Health Reform Bills Await Action by Gov. Brown

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By Consumers Union on Wednesday, September 28th, 2011

From California Watch http://bit.ly/psr6DT

With fanfare and triumphant speeches, former Gov. Arnold Schwarzenegger signed into law several bills that moved California to the forefront in enacting the national health reform law.

Whether California continues to forge ahead on the legal front now rests with Gov. Jerry Brown, who is expected to sign or veto several health reform bills by Oct. 9.

Last year, Schwarzenegger signed into law bills that created the health exchange, an entity that will craft a set of health insurance plans available at affordable prices by 2014. This year, Brown faces decisions on several other laws that would align state and federal law and help consumers find their way to the health exchange and other new coverage options.

One bill by Sen. Elaine Alquist, D-San Jose, would replicate federal guidelines on “medical loss ratio,” or the proportion of premium dollars that insurers will be expected to spend on patient care. Like the federal law, this measure would require that health insurers in the large group market spend 85 percent of premium dollars on services to patients. The law calls on insurers to issue rebates to employers and other health insurance customers if they fall short of the mark.

Another pending bill would revamp the Office of the Patient Advocate to be a central point of contact for Californians with questions or complaints about health coverage and services. Anthony Wright, executive director of Health Access, which sponsored the bill, said the office would simplify matters for people who now have to navigate eight different health-related agencies with questions or concerns about coverage or care.“We think that’s really important,” Wright said.

Another bill is meant to ensure that patients who qualify for new programs under health reform have “no wrong door” to signing up. For instance, thousands of additional patients will qualify for Medi-Cal when the poverty ceiling to qualify for the program is raised and opened to new classes of patients, such as single men.

The bill, by Assemblywoman Susan Bonilla, D-Concord, is meant to help an estimated 4.7 million additional people expected to qualify for coverage when health reform takes full effect in 2014. The bill would fend off scenarios in which people are confused and confounded about what they qualify for – and how to sign up.

Schwarzenegger vetoed one bill that would ensure that health insurers cover maternity care. Now a similar bill is on Brown’s desk. The former governor reasoned that the coverage mandate might make all policies more expensive and out of reach to more families.

However, health insurers continue to drop the option from health plans. While 82 percent of health insurance plans covered maternity care in 2004, the rate fell to 19 percent in 2009, according to an analysis of the Senate bill. Wright said maternity coverage is particularly difficult to come by for patients in Monterey and Redding, where few health insurance carriers offer it.

Brown’s signature on the bill would phase in the mandate to offer maternity care only about 18 months ahead of the health reform law, which defines maternity care as an “essential benefit” for insurers to offer by 2014.

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