[UPDATED at 6 p.m. PT on Sept. 4]
California lawmakers this year played offense and defense on health care, adopting bills to give patients more access to care and medications, while defending Californians against Trump administration attacks on the Affordable Care Act.
As they raced toward their Friday deadline to pass bills, legislators voted to make the abortion pill available to students on public college campuses, and to stop hospitals from discharging homeless patients onto the streets.
State lawmakers also countered some Trump administration regulations that health advocates say could have foiled California’s ongoing efforts to reduce its uninsured population. For example, they banned what they call “junk” plans, endorsed by President Donald Trump, that don’t meet ACA requirements.
“California has been extremely successful at implementing the Affordable Care Act,” said Deborah Kelch, executive director of the Insure the Uninsured Project, which advocates for expanded health care access. “The state of California has a very compelling reason to make sure we don’t lose those gains.”
While they blocked some Trump administration policies from taking effect in California, lawmakers’ attempts to expand coverage to more Californians were quashed by Democratic Gov. Jerry Brown’s fiscal conservatism. Single-payer health care wasn’t even on the table this year, despite the outsize role it has played in the 2018 political campaign season. And measures that would have expanded Medicaid to some of California’s low-income, undocumented immigrants failed — as did bills to create state-funded insurance subsidies for some residents. Instead, lawmakers passed a bill that calls for a study of a “public option” that would create a government-run health care program open to anyone.
“What we didn’t get this year, we’re getting ready for in the next governor,” said Jen Flory, a policy advocate at the Western Center on Law & Poverty, a nonprofit that advocates for low-income Californians.
Here’s a look at some of the major health care bills that California lawmakers have sent to Brown’s desk. He has until Sept. 30 to sign or veto them.
Defending the Affordable Care Act
Association Health Plans
The Trump administration earlier this year issued regulations that allow individuals to buy coverage through “association health plans,” which employers and associations can create to offer group health insurance. The bill, SB 1375, would bar individuals from such plans, which its author, state Sen. Ed Hernandez (D-West Covina), described as “junk insurance.”
Short-Term Health Plans
Parting ways again with the Trump administration, California lawmakers adopted SB 910 — also introduced by Hernandez — which would ban short-term health insurance policies. The plans, which can last up to 12 months, aren’t required to include key consumer protections guaranteed under the ACA, such as coverage for preexisting conditions.
Medical Loss Ratio
Lawmakers made clear they don’t want California to lower the amount insurers must spend on medical care after the Trump administration this spring gave states permission to modify what is known as the “medical loss ratio.” The Affordable Care Act required insurance companies to spend at least 80 percent of their premium income on health claims and quality improvement instead of administrative costs and profit. AB 2499, by Assemblyman Joaquin Arambula (D-Fresno), requires California insurers to maintain the 80 percent threshold.
Medi-Cal Work Requirements
Lawmakers approved legislation that would prevent California from imposing work requirements on its Medicaid recipients — or any other requirement that would make it harder for low-income families to get or use their health coverage, according to the bill’s proponents. Hernandez introduced the bill, SB 1108, after the Trump administration informed states they could implement work requirements, a change that critics say could kick people off the program.
Unloading Homeless Patients
Appalled by reports of homeless patients discharged from hospitals right onto the streets or into crammed shelters, lawmakers approved legislation intended to get these vulnerable patients to a safe location after they have received medical care. SB 1152, again by Hernandez, would require hospitals to develop a discharge plan for homeless patients.
Health Care Providers
Concerned that some patients with kidney disease and substance abuse addictions are being scammed, California lawmakers clamped down on for-profit, third-party health providers that enroll patients into private plans that reimburse providers more money, even though the patients might be eligible for Medicare or Medi-Cal. This can result in higher out-of-pocket costs and a disruption in care for the patients. Sen. Connie Leyva (D-Chino) has described her bill, SB 1156, as one that would end such insurance schemes and protect patients. Critics, including some dialysis patients, say the measure would limit the charitable financial assistance patients receive and prevent them from affording treatment.
Abortion Pills On Campus
Lawmakers want students at all 34 California State University and University of California campuses to have access to the abortion pill at student health centers. In some cases, pregnant students must now travel far for medical care, and that can delay their treatment, said Leyva, the bill’s co-author. SB 320 would require public universities to provide medical abortion services on campus by Jan. 1, 2022, to be paid for by private funds.
Rape Kit Testing
Angered by reports of untested rape kits, California lawmakers approved a pair of bills intended to audit the state’s backlog and require all new kits be tested going forward. AB 3118, by Assemblyman David Chiu (D-San Francisco), would require California’s first official statewide count of untested kits. Under SB 1449, co-authored by Leyva, law enforcement agencies would be required to submit evidence to a laboratory within 20 days, and those laboratories would need to process the kits within 120 days.
California lawmakers want the medical/pharmaceutical industry to take responsibility for unused prescriptions, used needles and other medical waste. SB 212, introduced by Sen. Hannah-Beth Jackson (D-Santa Barbara), would require manufacturers and distributors to create an industry-run and -funded program for Californians to dispose of medical waste. It would be implemented no later than 2022.
Hospital Nurse-Patient Ratios
The California Department of Public Health would be obliged to inspect hospitals periodically to ensure they’re complying with nurse-to-patient staffing ratios under another bill introduced by Leyva, SB 1288. Hospitals found to be violating those ratios could be fined. Ratios vary by ward — from 1:1 for trauma patients in the emergency room to 1:4 for pediatric patients.
Health Care Mergers
The legislature, concerned that consumers are facing restricted choice and paying higher prices as a result of consolidation, is demanding stronger state oversight of proposed health plan mergers. AB 595, by Assemblyman Jim Wood (D-Santa Rosa), would authorize the state Department of Managed Health Care to approve or block merger applications depending on their impacts on consumers.
California lawmakers want to regulate pharmacy benefit managers, which negotiate drug prices for patients, saying their dealings with drugmakers and insurance companies should be more transparent. AB 315, co-authored by Wood, would require these entities to be licensed by the Department of Managed Health Care and reveal certain cost information that could shed light on whether the savings they negotiate are passed on to consumers.