FEDERAL The next set of upcoming changes to health care reform provisions will occur in September. In addition, as the U.S. Department of Health and Human Services finalizes the rules to reform, there will be a “Comment Period” where advocates have the opportunity to provide suggestions to these changes.
September 23rd Provisions - Adult children can remain on parents’ health insurance policy until they reach age 27; - Elimination of insurance companies forcing lifetime limitations on services or cancelling insurance policies; - Transparent appeals process for new group and individual insurance plans. Insurance companies must now share how they determine decisions when a claim denial is appealed; - No cost preventative care. Insurance companies can no longer charge for services that are considered preventative or maintenance care (immunizations, physicals, pap smears, mammograms, etc.); - No denial of coverage for children with preexisting conditions; - Required reporting of Loss Ratio (MLR) is the amount of premium dollars that does not go directly to medical care. Rather, it goes to advertising, inflated CEO salaries, company retreats, etc.
STATE As the deadline to pass all bills (August 31st) is approaching, law makers must vote upon crucial health care reform bills that meet the federal requirement under health care reform. To date, some bills have passed both houses and await the Governor’s signature (who has stated he will sign) and others have not. Bills that remain in either the Assembly or the Senate have been those that seek to regulate the health insurance industry. Strong opposition to these bill has come from insurance companies and will require advocates to continue to mobilize support around their passage. Bills Passed (Go to Governor for signature: > Exchange Bills - AB 1602 (Perez) Creates the Exchange where the public can purchase insurance and make comparisons in plans and price; - SB 900 (Alquist/Steinberg) Creates the Exchange and is the companion bill to AB 1602; California is first state to create the Exchange in the country. Pending Votes in the Senate: - AB 2578 (Jones) Requires health insurance companies to submit requests and obtain approval to Dept. of Insurance with justification before implementing any rate hikes or fees on consumers; - AB 2244 (Feuer) Limits premium costs for covering children with preexisting conditions; Pending Votes in the Assembly: - SB 1163 (Leno) Requires insurance companies to provide reasons for denying, increasing prices and other changes to a plan. - SB 890 (Alquist) Creation of a set of standard benefits for every health plan sold in California;
