California led the nation with the biggest drop of the uninsured rate of any state by implementing and improving on the Affordable Care Act. With 93% of Californians covered, our state is ready for the next bold steps to achieve a universal health care system that is affordable, accountable, and equitable.
Over 50 organizations launched a bold new campaign to tackle the remaining obstacles to win Care4All California in the next year or two, without help or the need of approvals from the federal government.
Updated 10/1/2018. Note: Of this comprehensive list of the bills supported by the Care4All CA campaign in 2018, nine priority bills (bolded and denoted with a *) made it to the Governor.
PROTECT PATIENTS, STOPPING THE SABOTAGE OF OUR HEALTH SYSTEM
The Republican Congress continues to try to repeal the ACA, and the Trump Administration has taken a series of regulatory steps to undermine our health system in general, including making it harder for people to enroll in Medicaid and opening loopholes in patient protections for insurance companies to sell plans that exclude patients with preexisting conditions or don’t cover basic services like maternity care, mental health treatment, and prescription drugs. California must protect its consumers to:
- Limit Substandard Insurance promoted by the Trump Administration from trapping consumers in “junk” coverage, undermining our insurance markets and increasing premiums, by:
- Banning substandard so-called “short term” coverage, SB 910 (Hernandez)* SIGNED by Governor Brown
- Limiting the sale of substandard “association health plans”, with SB 1375 (Hernandez)* SIGNED by Governor Brown
- Ensuring the Value of Health Coverage: Require health plans spend 80% of our premium dollars on health care, limiting administrative costs and profits—even as the Trump Administration encourages states to lower the “medical loss ratio” to 70% AB 2499, (Arambula)* SIGNED by Governor Brown
- Prevent Restrictions to Medicaid Eligibility: Prohibit the state from pursuing waivers that make it harder for low-income people to enroll in Medi-Cal. SB 1108 (Hernandez)* SIGNED by Governor Brown
- Maintain stability in the individual market and prevent premium spikes by maintaining the individual mandate, improving affordability in Covered California and encouraging enrollment.
COVER ALL CALIFORNIANS, INCREASING UNIVERSALITY AND AFFORDABILITY
Everybody benefits when everyone is covered, sharing in the cost of care and getting primary and preventive services to stay healthy. Specific state budget and policy steps can remove exclusions in our public programs and increase affordability to reduce our uninsured rate from 7% down to 1%.
- #Health4All: Medi-Cal should cover all income-eligible adults regardless of their immigration status. Of the 2.8 million Californians who remain uninsured, 58% are undocumented adults, who are excluded from comprehensive Medi-Cal. (SB 974, Lara; AB 2965, Arambula)
- Increase Affordability and Take-Up of Coverage: ACA subsidies have helped millions of people afford health coverage, but more help with affordability is needed, especially in a high cost state like California. For those who have a subsidy but who still can’t afford premiums, deductibles, or co-pays and those who earn too much to qualify for a subsidy, increasing affordability assistance will help more Californians get covered and reduce their costs for premiums and cost-sharing. (SB 1255, Hernandez; AB 2459, Friedman; AB 2565, Chiu)
- Undo the “Senior Penalty” in Medi-Cal, aligning income-eligibility for the Medi-Cal Aged and Disabled Program with income eligibility for those under age 65. This will ensure over 20,000 California seniors and people with disabilities don’t face high share of costs for coverage (AB 2430, Arambula)
- Streamline and Encourage Enrollment by instituting express lane enrollment for those in the WIC program. (AB 2579, Burke)
REDUCE HEALTH CARE PRICES, IMPROVING QUALITY & EQUITY THROUGH ACCOUNTABILITY
The United States spends more than most industrialized countries on health care, not because we use more services or have better health outcomes, but because prices are higher. Rising prices have eroded coverage, showing up in our premiums, deductibles, and co-pays—and in lower paychecks. Our higher prices are driven by consolidation, lack of oversight, and industry profit motives. For any health system to be sustainable, we must lower prices while improving quality and reducing health disparities.
- Contain Costs: Establish an independent Health Care Cost, Quality and Equity Commission to set reasonable base amounts hospitals, doctors, and other providers of health care can collect from payers. (AB 3087, Kalra)
- Study the Feasibility of a “Public Option” in Covered California and the broader individual insurance market and the state overall. The bill would have the new Council on Health Care Delivery Systems to investigate explore the notion of a public health insurance option, especially so that no region of California is left with only one or zero plans, at the whim of private insurers. AB 2472 (Wood)* SIGNED by Governor Brown
- Ensure Quality in Medi-Cal Managed Care: Ensure the Medi-Cal managed care plans that cover nearly one-third of Californians are accountable for improving health care quality and reducing disparities. AB 2275 (Arambula)* VETOED by Governor Brown
- Address Health Industry Consolidation
- Increase Oversight of Health Plan Mergers AB 595 (Wood)* SIGNED by Governor Brown
- Prohibit anticompetitive contract clauses by hospital oligopolies. SB 538 (Monning)
- Continue Efforts to Rein In Prescription Drug Prices
- Regulate Pharmacy Benefit Managers (PBMs). AB 315 (Wood)* SIGNED by Governor Brown
- Extend the Prescription Co-Pay Cap of $250, and other consumer protections. SB 1021 (Wiener)* SIGNED by Governor Brown
The 2018-19 State Budget also included two related provisions, creating and funding a Health Care Cost Transparency Database to track health prices and payments, and a Council on Health Care Delivery Systems to develop a plan for an improved system for all Californians with unified financing.