Essential Health Benefit Bill Clears Committee

Bill Monning, chair of the Assembly Committee on Health, knew the moment was a big one.

“We are serving as policymakers in extraordinary times,” Monning (D-Carmel) said yesterday at the health committee hearing. “For up to 5 million Californians, we have the opportunity before us to set essential health benefits.”

Monning introduced AB 1453, which laid out a plan for what essential benefits will be covered in California under the Affordable Care Act. The proposed set of benefits is modeled on the Kaiser small group HMO plan.

“This is one of the most important bills you will face this year,” Beth Capell of Health Access California told the committee.

The federal government requires states to choose essential benefits in 10 broad categories. In California, that process looked daunting because of the many health care mandates passed by the Legislature, including coverage of autism.

This package includes all current California mandates — including autism coverage — and everything in the package fits the federal profile as well, which means there would be no extra mandate costs to the state, Monning said.

“We’ve tried to find the best combination of coverage and cost affordability,” Monning said. “By our selection of this benchmark, there’s no additional cost to the state. Because autism is embedded in this benchmark, Californians would not have to defray the costs of that benefit.”

The Kaiser small group plan covers reproductive services, acupuncture,  prescription drugs and all of California’s current mandates, Monning said. “And best of all, it is affordable,” he said.

There was no stated opposition to the bill, but Nick Louizos of the California Association of Health Plans said his organization has some reservations about the bill. He was pleased, he said, to see the legislative discussion focus on selection of the benchmark plan.

“This is not like the typical parade of mandate bills,” Louizos said. “Coverage mandates is not the discussion to have at this point. We do think that, with selection of essential benefits, it’s crucial that the terms and definitions not run afoul of federal law.”

Stephanie Watkins, from the Association of California Life and Health Insurance Companies, also had measured praise for the process.

“We are also one of the tweeners,” she said. “We appreciate the open dialogue — there’s been an open forum — but we still have some concerns with some of the language.”

Monning, calling the selection of benefits a work in progress, said “progress” is the operative word.

“A lot of work has gone into this,” Monning said. “We’re not there yet. If there are fundamental changes, it’ll come back to this committee for review.”

The bill passed committee, and now heads to Appropriations.

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