Long-Term Care Premium Protection & Other Key Health Care Bills Pass California Legislature

A number of important health care bills passed the California State Legislature last week. One bill, AB 999 authored by Assembly Aging and Long-Term Care Committee Chair Mariko Yamada (D-Davis) protects consumers from excessive premium rate increases by modifying the long-term care insurance (LTC) premium rate development process. It also helps consumers make more informed choices about buying a policy by giving them the opportunity to review a policy’s language before purchase. More can be read about this bill in the California Department of Insurance’s recent press release.

The other health care bills, if signed by the Governor this month, will ensure that California is ready to adopt the many health care reforms scheduled to begin in 2014. While federal law under the Affordable Care Act includes many provisions, resources and a platform for improving the quality, coverage and protections in our health care system, it is still up to each state to bring this law into reality, to enforce the new consumer protections, and make sure Californians know about and enroll in to their new coverage options. Health Access recently published a brief summary (PDF) of the legislation; below is an excerpt from their press release.

Consumer Protections and Insurance Reform

AB1453 (Monning)/SB951 (Hernandez) ESSENTIAL HEALTH BENEFITS: Protects consumers from underinsurance and junk insurance by requiring health plans to cover a set of minimum essential health benefits equivalent to the Kaiser Small Group HMO.

SB961 (Hernandez)/AB1461 (Monning) REFORMING THE INDIVIDUAL MARKET: Prevents insurers from denying or discriminating for pre-existing conditions, and otherwise conform and phase-in new insurance market rules for individuals who purchase insurance on their own. Limits different premiums based on age to 3:1.

AB1083 (Monning) REFORMING THE SMALL GROUP MARKET: Puts in place the new insurance oversight and consumer protections in the market for small employers, preventing overcharging for small businesses with sicker workers, etc. [Still pending]

AB1526 (Monning) IMPROVING THE HIGH RISK POOL: Improves the Major Risk Medical Insurance Program (MRMIP) by eliminating annual and lifetime caps so that individuals with pre-existing conditions will be protected if they are in need of extremely costly care, and brings the program in line with PCIP, the federally funded high risk pool.

SB1410 (Hernandez) INDEPENDENT MEDICAL REVIEW: Improves the process by which consumers appeal denial of care decisions by making the process more robust and transparent.  Also requires collection of race, ethnicity, and language data to help determine whether health equity issues need to be addressed.

AB1761 (Perez) EXCHANGE MISREPRESENTATION: Prohibits any indiividual or entity from falsely representing themselves as the California Health Benefits Exchange.

Informing and Enrolling Californians in New Coverage Options

AB792 (Bonilla) COVERAGE DURING LIFE CHANGES: Provides notice so that Californians can easily sign up for coverage during key life changes. Requires California consumers are provided information about the Exchange upon losing coverage for due to job change, divorce, separation, unemployment, adoption, or other life circumstances.

SB970 (DeLeon) HORIZONTAL INTEGRATION: Helps individuals applying for public programs apply through an integrated no wrong door approach, whether applicants are interested in social services or health programs.

AB1580 (Bonilla) ELIGIBILITY AND ENROLLMENT: A follow-up to last year’s AB1296 to streamlining eligibility and enrollment processes in Medi-Cal and other health programs.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.