Legislature to Consider Numerous Health Care Benefit Mandate Bills

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‘Essential Benefits’

Federal health care reform includes an essential health benefits package. At this time it is unclear what will be covered as an essential benefit, and it is likely that the essential benefits will not be determined for another year. The essential benefits are required to be covered by any plans offered in the California Health Benefits Exchange.

All subsidized individuals will be required to purchase their coverage through the exchange. For any individual who receives a subsidy, the state must pay for any benefits provided in excess of the federal essential benefits. The cost to the state would have to be borne by the state General Fund.

Outside the exchange, benefit mandates — as they do now — increase premium costs and the ranks of the uninsured.

Health Care Benefit Mandates

Following is a sampling of California Chamber of Commerce-opposed health care benefit mandate bills awaiting action by the Legislature. Other mandates increasing health insurance premiums may be identified in the future.

AB 72 (Eng; D-Monterey Park) mandates that all health policies cover acupuncture services. Assembly Health Committee hearing May 3.

AB 154 (Beall; D-San Jose) mandates that all health policies cover an expanded list of mental health services. Assembly Appropriations Committee Suspense File.

AB 171 (Beall; D-San Jose) mandates health plan coverage beyond medically necessary treatment for autism by requiring coverage of services that are educational, academic or custodial in nature. Assembly Health hearing April 26.

AB 185 (Hernandez; D-West Covina) mandates that all health insurance policies provide maternity coverage. Assembly Appropriations Suspense File.

AB 369 (Huffman; D-San Rafael) eliminates current cost controls and unravels consumer protections in the use of prescription pain medicines by eliminating the practice of step therapy. Assembly Health hearing April 26.

AB 1000 (Perea; D-Fresno) limits co-payments for one type of pharmaceutical: orally administered anti-cancer medications. Assembly Health hearing May 3.

SB 166 (Steinberg; D-Sacramento) mandates health plan coverage beyond medically necessary treatment for autism by requiring coverage of services that are educational, academic or custodial in nature. In Senate Health Committee.

SB 136 (Yee; D-San Francisco) mandates that health policies cover smoking cessation services. Senate Health hearing April 27.

SB 155 (Evans; D-Santa Rosa) mandates that all health insurance policies provide maternity coverage. Senate Health hearing April 27.

CalChamber Position

While the mandate bills are well-intentioned, the CalChamber believes they will exacerbate the problem of rising health care costs. Although any one bill may increase health care premiums only minimally, the increase cannot be viewed in isolation.

Health care mandates have reduced health plans’ flexibility in benefit design, and increased health care costs and premium rates, thereby reducing employers’ choice of benefit packages to offer their employees and contributing to the need for health care reform today.

Benefit mandates make insurance less affordable, further contributing to an increased number of individuals without insurance.

Action Needed

The CalChamber is urging its members to contact their representatives to oppose these health care mandates.