California Gov. Jerry Brown, who faced the final bill-signing deadline of his gubernatorial career on Sunday, approved a variety of health care measures that will directly affect consumers — right down to the drinks in their children’s kiddie meals.
Some of these laws broke ground nationally, such as one that will require doctors to notify patients if they’ve been placed on probation for serious misconduct. Others exemplify California’s ongoing resistance to Trump administration policies.
“We are fighting against the federal government’s continuous assault on California’s insurance market and the health care of millions,” said state Sen. Ed Hernandez (D-West Covina), after Brown signed a package of his health care measures, including one that will prevent the state from imposing work requirements on its Medicaid recipients.
Most of the laws take effect next year, unless the measures specify otherwise.
Brown, a Democrat, also rejected several health care proposals, including one that would have required student health centers at public university campuses to make the abortion pill available.
Next year, a new governor will determine the fate of health care legislation. Voters will decide on Nov. 6 whether it will be Republican John Cox or Democrat Gavin Newsom.
KIDS’ HEALTH
Pot On School Campuses
Brown rejected a controversial bill, SB 1127 by state Sen. Jerry Hill (D-San Mateo), which would have let school districts decide whether to allow parents to bring and administer medical marijuana to their kids on school grounds, which are supposed to be drug-free zones.
Kids’ Restaurant Meals
The governor signed a bill, SB 1192 by state Sen. Bill Monning (D-Carmel), requiring restaurants to serve water or milk as the default drink option with kids’ meals, not sugary beverages such as sodas. However, kids or parents can still request a different drink. Monning had cited “a public health crisis where rates of preventable health conditions like obesity and Type 2 diabetes are skyrocketing.”
Services For Low-Income Kids
Brown gave the green light to SB 1287 by Hernandez, which will amend state law to ensure that children on Medi-Cal can access the wide array of treatments they’re entitled to under federal law — services that some children are denied. These include treatments to improve physical or mental health conditions or substance abuse disorders.
PRESCRIPTION DRUGS
Abortion Pill
Brown nixed a bill that would have given students at the 34 California State University and University of California campuses access to the abortion pill at student health centers. SB 320, by state Sen. Connie Leyva (D-Chino), would have required the public universities to make the medication available, paid for by private funds. In a veto message, Brown noted that a study commissioned for this bill showed the average distance from campuses to an abortion provider is about 5 to 7 miles, which is “not an unreasonable distance.”
Drug Disposal
The governor signed SB 212, by state Sen. Hannah Beth-Jackson (D-Santa Barbara), which requires the pharmaceutical and medical industries to create, fund and run a program to help Californians dispose of unwanted prescriptions, used needles and other medical waste. The new program must be implemented no later than 2022.
Drug Prices
Brown signed AB 315, by state Assemblyman Jim Wood (D-Santa Rosa), requiring pharmacy benefit managers, which negotiate drug prices for patients, to be licensed by the Department of Managed Health Care and reveal certain cost information to show whether savings they negotiate are passed on to consumers.
Opioid Addiction Treatment
Brown rejected AB 2384, by state Assemblyman Joaquin Arambula (D-Fresno), which would have required private insurers to cover certain medications for opioid addiction without requiring a preapproval process. He also vetoed a different measure, AB 186 by Assemblywoman Susan Eggman (D-Stockton), which would have allowed San Francisco to establish safe sites for people to inject illicit drugs under medical supervision.
COUNTERING TRUMP
Short-Term Plans And Association Health Plans
Brown gave the green light to two Hernandez bills that will dramatically restrict health plans that offer fewer benefits and protections than those that comply with the Affordable Care Act. SB 910 bans the sale of short-term health plans, which can last up to 12 months, deny coverage to people with preexisting conditions and are not required to cover some benefits, like cancer treatment or maternity care. The other bill, SB 1375 bars individuals from buying association health plans, which may also skimp on ACA protections.
Insurer Profits
Earlier this year, the Trump administration gave states permission to modify what is known as the “medical loss ratio,” which establishes how much insurers must spend on medical care. But Brown signed AB 2499 by Arambula, which requires California health plans purchased directly by individuals and families to continue to spend at least 80 percent of premium income on medical care rather than administrative costs and profits. That figure is 85 percent for large employer coverage.
Medi-Cal Work Requirements
Also approved by Brown, SB 1108 will prevent California from establishing work requirements for Medicaid beneficiaries. Earlier this year, the Trump administration opened the door for states to impose such requirements. Arkansas was the first state to do so.
PUBLIC HEALTH
Hospital-Nurse Patient Ratios
Brown vetoed SB 1288 by Leyva, would have required the state Department of Public Health to inspect hospitals to ensure they’re complying with nurse-to-patient staffing ratios, which vary by ward from 1:1 for trauma patients to 1:4 for pediatric patients.
Unloading Homeless Patients
Brown signed another bill by Hernandez, SB 1152, which will require hospitals to develop a discharge plan for homeless patients, so they are not dumped onto the streets or into crowded shelters.
Fire Retardants
Brown also approved AB 2998 by state Assemblyman Richard Bloom (D-Santa Monica), which prohibits the sale of upholstered furniture, mattresses and children’s products that contain certain levels of flame retardant chemicals that have been linked to health problems such as cancer. This law goes into effect Jan. 1, 2020.
Maternal Mental Health
Brown signed AB 2193 by state Assemblyman Brian Maienschein (R-San Diego), which will require a physician providing prenatal or postpartum care to screen new moms for maternal mental health disorders, such as postpartum depression. This requirement takes effect July 1, 2019.
MISCELLANEOUS
Emergency Health Care In Fires
Brown approved AB 2576 by state Assemblywoman Cecilia Aguiar-Curry (D-Winters), one of many bills introduced in response to California’s destructive wildfires. The measure will allow clinics and health centers to be paid for services performed outside of a health facility during a wildfire. These services can include home visits, phone appointments and checkups inside evacuation shelters.
Health Care Mergers
The governor signed AB 595 by Wood, which will give the state Department of Managed Health Care new authority to approve or reject proposed health plan mergers, based on their impact on consumers.
Rape Kit Testing
The governor greenlighted AB 3118 by Assemblyman David Chiu (D-San Francisco), authorizing California’s first official statewide count of untested rape kits. But Brown vetoed a related bill, SB 1449 by Leyva, which would have required law enforcement agencies to submit evidence from an alleged rape to a laboratory within 20 days and given the lab 120 days to process it.
Doctor Probation
After several attempts, Sen. Hill finally prevailed with his bill requiring doctors who have been placed on probation by state regulators for serious misconduct to notify patients of their disciplinary status before their first visit. This law goes into effect July 2019 and will apply to doctors disciplined on or after that date.
Health Care Providers
Brown rejected another Leyva bill, SB 1156, which would have clamped down on for-profit dialysis centers, rehab clinics and other third-party health providers that enroll patients in more lucrative private plans, even if the patients might be eligible for Medicare or Medi-Cal. This practice can result in higher out-of-pocket costs and a disruption in care for the patients. The law would have required these third-party providers to notify patients of all available health coverage options.