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State Lawmakers Tackle Public Smoking And Lead Poisoning, But Punt On Single-Payer

Sacramento, California, United States - June 10, 2013: The California State Capitol is the seat of the government of California, housing the chambers of the state legislature and the office of the governor in Sacramento, California.

California lawmakers approved several key health care proposals — and stalled on others — in their mad dash toward last Friday’s do-or-die legislative deadline.

They adopted a bill that would require drugmakers to give 60 days’ notice on big price hikes, but pushed off a decision on single-payer health care. They banned smoking at state parks and beaches, but delayed a proposal that would have established staffing requirements for dialysis clinics.

Some state legislators faced dual health care challenges this year: They lobbied to get their own bills passed while pushing back against attempts in Congress to repeal and replace the Affordable Care Act.

State Sen. Ed Hernandez, chairman of the Senate Health Committee, said his priority was “to make sure we secured what we have … and that no consumer was going to be left without insurance.”

As a result, the focus of his legislative work this year became “mostly consumer protection and a lot of defense,” the West Covina Democrat said. He cited the example of his bill to protect access to Planned Parenthood and other reproductive health clinics, which passed last week.

Democratic Gov. Jerry Brown has until Oct. 15 to sign or veto the bills adopted by the Legislature. Other health policy proposals were shelved for now, and may be resurrected next year.


Keeping Your Doctors

In response to the impending departures of Anthem Blue Cross and Cigna from portions of California’s individual insurance market next year, lawmakers agreed to a measure that would allow some seriously ill patients to continue seeing their current providers for a limited time if their insurer discontinued their plan. Under SB 133, introduced by Hernandez, an eligible patient’s coverage would continue even if her doctors didn’t contract with the new health plan, so long as they were willing to accept the new plan’s reimbursement rates.

Reproductive Bias

The Legislature gave the green light to a measure by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego) to prohibit institutions with religious affiliations from firing workers because of their reproductive choices, such as becoming pregnant out of wedlock or having abortions. AB 569 would bar a religion-based employer such as a Christian school from requiring workers to sign a code of conduct that waived their reproductive health rights.

Prescription Drug Costs

After a similar proposal fizzled last year, lawmakers last week supported a hotly contested bill by Hernandez that would require drugmakers to report and explain big price hikes. SB 17 directs pharmaceutical companies to notify state agencies and insurers 60 days in advance if they plan to raise prices more than 16 percent over two years on drugs with a wholesale cost of at least $40.

Lawmakers also approved AB 265 by Assemblyman Jim Wood (D-Healdsburg), which would ban drugmakers from giving consumers coupons for brand-name drugs when a generic equivalent was available, with some exceptions.

Open Enrollment

Legislators agreed that Californians who buy insurance for themselves should continue to have a three-month open enrollment period, during which they can choose or switch health plans. By adopting AB 156, also authored by Wood, lawmakers are exempting the Golden State from a Trump administration rule that shortens the sign-up period to 45 days. If endorsed by the governor, the law would apply to people who purchase plans from Covered California and in the open market for coverage in 2019 and beyond. These Californians already are assured a three-month open enrollment period for next year, which will run from Nov. 1 to Jan. 31.

Smoking At State Parks And Beaches

Lawmakers approved AB 725 by Assemblyman Marc Levine (D-San Rafael) to ban smoking at state beaches and parks. Violators would face fines of up to $50 per incident. Gov. Brown vetoed a similar effort last year, calling it “too broad.” A similar bill by Sen. Steve Glazer (D-Orinda), which proposes a fine of up to $100, also awaits the governor’s decision.

Childhood Lead Poisoning

Legislators adopted AB 1316 by Assemblyman Bill Quirk (D-Hayward), which would strengthen the state’s screening for lead poisoning in children. The bill calls for all California kids to be evaluated by their doctor during regular checkups, and for those deemed “at risk” to undergo a blood screening. Currently, children who receive government assistance such as Medi-Cal must be screened for lead, but that requirement doesn’t extend to other children.


Regulating Dialysis Clinics

A proposal by Sen. Ricardo Lara (D-Bell Gardens) would have required minimum staff-to-patient ratios at dialysis centers, such as one nurse for every eight patients or one technician for every three. The stalled bill, SB 349, also would have mandated more time for staff to prepare between patient appointments. A bill by Assemblyman Rob Bonta (D-Oakland) would have required dialysis centers to spend at least 85 percent of their revenue primarily on direct patient care.

Both measures were backed by a large labor union, Service Employees International Union-United Healthcare Workers West (SEIU-UHW), which has threatened to take the issue directly to voters if the Legislature does not act.

Single-Payer Health Care

The ambitious attempt to create one government-administered or “single-payer” health care system in California has been tabled until next year. SB 562 by Lara and Assemblywoman Toni Atkins (D-San Diego) would provide comprehensive health coverage to all Californians, regardless of immigration status. Private insurance companies would be barred from the system, and enrollees would not be charged copayments or premiums. A legislative committee estimated that the program would require $200 billion annually in additional tax revenue.

Supporters of universal health care hope to put a measure on the statewide ballot that would make it easier to fund a single-payer system.

Pediatric Dental Anesthesia  

A bill that would have required oral surgeons to have a specially trained staff member with them to monitor a child under anesthesia stalled in committee. Current law allows an oral surgeon to perform surgery and monitor the unconscious child at the same time. AB 224, by Assemblyman Tony Thurmond (D-Richmond), would have built on last year’s “Caleb’s Law,” named after Caleb Sears, a 6-year-old boy who died in 2015 after oral surgery under anesthesia.

Containing Drug Costs

A measure by Assemblyman David Chiu (D-San Francisco) would have brought together administrators from 17 state agencies to devise ways to reduce state drug costs. AB 587 would have expanded an existing state purchasing collaborative that buys drugs for a handful of public health programs, and directed the new group to develop cost controls, such as creating a uniform drug formulary for state agencies.

SB 790 by Sen. Mike McGuire (D-North Coast/North Bay) sought to restrict the pharmaceutical industry’s marketing to doctors, limiting their spending to mostly educational or scientific purposes, which McGuire said could reduce unnecessary prescriptions of pricey drugs.

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