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Late last week the California State Legislature passed a series of bills designed to help prevent unfair medical charges, excessive health insurance rates, and misleading information about access to health care providers. Together these bills, if signed into law by Governor Jerry Brown, will help promote a more consumer friendly and affordable health care system in California.
More Accurate Healthcare Provider Directories
SB 137, authored by Senator Ed Hernandez, will give consumers accurate, up-to-date information about which doctors, hospitals, clinics and other providers are in a health plan’s network. This information will help consumers pick the right plan as well as avoid accidentally going to an expensive out-of-network provider.
Limiting Specialty Drug Costs
AB 339, authored by Assembly Member Richard Gordon, will help people with chronic health conditions by ensuring they are not discriminated against by a health plan or insurer because of their health condition. The emergence of very high cost specialty drugs has led health plans and insurers to impose high copays and coinsurance on many drugs, including drugs for conditions such as asthma, HIV/AIDS, hepatitis, cancer, multiple sclerosis and other serious conditions. This bill protects Californians by reducing cost barriers to prescription drugs needed by individuals with chronic health conditions.
Caps on Deductibles and Out-of-Pocket Maximums
AB 1305, authored by Assembly Member Rob Bonta, will limit deductibles and annual out-of-pocket maximums for individual members of families. Under the Affordable Care Act, deductibles and annual out-of-pocket maximums are limited to $6,600 for individuals and $13,200 for a family. However, the family’s out-of-pocket maximum could be met by the care of one individual member of the family, even if every other family member is healthy and needs no care throughout the year. AB 1305 removes this inequality between individuals and families, by limiting deductibles and annual out-of-pocket maximums to the individual limit when the individual is a member of a family. This legislation will save a family as much as $6,600 in out-of-pocket costs.
Rate Review of Large Group Health Plans
SB 546, authored by Senator Mark Leno, will help contain the cost of health care by requiring rate review for health insurance rate increases in the large group market. Under current law, health insurance carriers are required to share their justification for rate increases for individual and small group plans with state regulators. SB 546 would apply that requirement to the large group market. This would give employers and union trust funds the tools they need to ensure premiums are reasonable and justified by their insurance providers.
CALPIRG is urging Governor Brown to sign all four of these bills into law.
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