California Moves on Health Reform in 2012 with a Host of Measures

The CO-OP rule and statute were designed to ensure that state legislation would not be needed for a state to have a private, non profit CO-OP. It must comply with state requirements for licensure, under Department of Health and Human Services (HHS) guidelines.

However, AB 1846 would further mandate that a CO-OP must adhere to the California Health Benefit Exchange's standards and its selective contracting requirements, including rate negotiations.The bill passed out of the Assembly Health Committee on a vote of 6 to 3. 

In Washington, D.C., the HHS's Centers for Medicare and Medicaid Services (CMS) received a request for CO-OP records on April 24 and says it plans to respond to it. 

Then, there is AB 1921, which implements part of the PPACA by establishing the state Transitional Reinsurance Program. Each state operating a health benefit exchange may establish a transitional reinsurance fund program from 2014 to 2016 used to pay health insurers and HMOs writing in the individual market that incur large claims by individual policy holders from 2014 to 2016. This California bill is designed to address the possibility that some insurers and HMOs will have higher risk policyholders than others. It passed out of the Assembly Health Committee on a vote of 6 to 3. 

SB 1431, passed out of the Senate Health Committee on a vote of 5 to 3, proposed to regulate the sale of stop-loss insurance to small businesses by insurers that are promising these slimmed-down health benefit plans without the same level of strong consumer protections given under federal healthcare reform, which prohibits the consideration of health status and medical history.

Under Jones, CDI's  track record has been 12 CDI-sponsored bills in his first year of 2011, of which nine  passed out of the Legislature and were sent to the governor; all 9 bills were signed into law.  This equals 75% of total sponsored bills last year  passed out of the Legislature and 100% of those CDI-sponsored bills that were sent to the governor were signed.  

For 2012, there are presently 10 CDI-sponsored bills.

There are two other bills that Commissioner Dave Jones sponsored that are not moving so fast–they were and were introduced last year, which are in their second house and can be acted on later this year:

•  AB 52, would give legal authority to the insurance commissioner to reject excessive health insurance rate increases by requiring health plans and insurers to seek approval from state regulators before raising health care premiums, copayments, or deductibles. This is the same authority that the insurance commissioner currently has for auto, property, and casualty insurance. 
• AB 999, a bill to modify the long-term care insurance premium rate process to protect consumers from rate volatility, remains stuck in the Senate Insurance Committee.