San Francisco Chronicle by Wyatt Buchanan –
February 10, 2013:
California leaders are getting ready to consider legislation to expand health insurance coverage to millions of uninsured state residents as the start date of the federal Affordable Care Act moves closer.
The act was signed into law by President Obama in 2010, but California must still pass bills to expand its Medicaid program, known as Medi-Cal, for more than 1 million new people and set the rules that the insurance industry must follow when individuals begin to purchase medical insurance through an open market exchange.
Starting next week, lawmakers at the Capitol will hold hearings on bills that will help California set the stage for Obamacare.
“These are the bills that make these reforms real,” said Anthony Wright, executive director of Health Access California, a health care advocacy organization. “In order for these consumer protections to be enforced by our regulators, they need to be in state law. In order for coverage expansion to happen, we need to put these changes to Medicaid in state law.”
Lawmakers will meet in a special session of the Legislature, which means whatever bills they pass will take effect 90 days after they are signed into law by Gov. Jerry Brown instead of at the start of the next year. Hearings will start Feb. 19, and the bills are expected to move rapidly through the Legislature.
Many of the details are technical, and lawmakers and officials in Brown’s administration are moving quickly to ensure that rules are in place for two big deadlines: the beginning of open enrollment for those who will be newly eligible for Medi-Cal and those who will buy health insurance through the new state exchange, and for the Jan. 1, 2014, start date for the health care law.
The open enrollment period is tentatively scheduled to begin Oct. 1, but that could be delayed if a new computer system is not ready for use.
Many people see the implementation of the law as the biggest change in the United States’ health care system since the implementation of Medicare and Medicaid in 1965, but Diana Dooley, the secretary of the Health and Human Services Agency who is leading the state’s effort for Brown, said she thinks it is more difficult than that.
Issues to be decided
“It’s very significant and in many ways it’s harder because it’s almost always easier to build something from nothing than to rehabilitate, if you will,” Dooley said. Much of what lawmakers and other officials have to consider are technical changes to the already existing programs, which themselves have had many changes over the past nearly 50 years.
The biggest issues lawmakers will consider include:
— Whether to have the state or counties run the program for those who are newly eligible for Medi-Cal. The federal law expands the income limits for people to be eligible for the program and, while the federal government will pick up 100 percent of the cost the first three years, that eventually will be scaled back to 90 percent.
— How to structure new mandates for insurance companies to cover people regardless of a pre-existing condition and for individuals to purchase health care coverage, and whether to require any additional health benefits beyond what is required by federal law.
Health insurers in California would like to see the state stick to just what is in the federal law, and they want to see the coverage mandate and the purchase mandate tied together.
A bill passed last year did not tie those together, and it was vetoed by Brown because he said it could lead to people waiting until they were sick or injured to buy health coverage.
“Those two go together, meaning health plans must accept all comers without regard to pre-existing condition and individuals have a duty to be covered with health insurance,” said Patrick Johnston, president and CEO of the California Association of Health Plans.
U.S. rules unfinished
Whatever the Legislature and governor agree to, the federal government still hasn’t finalized all the rules for implementing the law, which means state leaders will have more work to do in the future.
“We are not going to have all the information we need to do everything everyone wants to do. We have more information than we had in October, more than we had in December, but less than we’ll have in June,” said Dooley, who added that the state can’t wait forever for the federal government.
“Each week that passes, we impair our ability to meet that deadline of Jan. 1, 2014,” she said.