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Ass'y Speaker Rendon Will Withhold Action -- For Now -- On Proposed State Gov't Run "Single Payer" Health Care System (Sen. Lara's SB 562), Calls Current Bill "Woefully Incomplete" But Says It's Not Dead (Read Full Statement)


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(June 23, 2017, 6:55 p.m.) -- This afternoon (June 23) Assembly Speaker Anthony Rendon (D, NLB-Lakewood-Paramount) issued a statement (full text below) announcing he's withholding Assembly action -- for now -- on SB 562, a bill introduced and co-authored by state Senator (and Insurance Commissioner candidate) Ricardo Lara (D, Long Beach-Huntington Park) that would create a state government run "single payer" health care system.

In his statement, Assembly Speaker Rendon said SB 562 (which cleared the state Senate) isn't dead for the two year legislative session, just for this first year. Speaker Rendon said the two year legislative session "leaves open the exact deep discussion and debate the senators who voted for SB 562 repeatedly said is needed" and added "the Senate can use that time to fill the holes in SB 562 and pass and send to the Assembly workable legislation that addresses financing, delivery of care, and cost control."

Speaker Rendon's statement added: "The fight for single payer also is moving forward on other fronts. The head of the Campaign for a Healthy California, an organization created to pass SB 562, has acknowledged their ultimate goal is to get a single payer initiative on the ballot, and there remains ample time for them to pursue that before November 2018."

[Scroll down for further.]

[Statement by Assembly Speaker Rendon] Yesterday, Republicans in the U.S. Senate released a cynical plan to repeal the Affordable Care Act, posing a real and immediate threat to millions of Californians who only have health coverage because of the ACA.

Preparing California to meet this threat must be the top health care priority for the Legislature, Governor Brown, and organizations that advocate for increasing access to health care.

As someone who has long been a supporter of single payer, I am encouraged by the conversation begun by Senate Bill 562.

However, SB 562 was sent to the Assembly woefully incomplete. Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump Administration and voters to make SB 562 a genuine piece of legislation.

In light of this, I have decided SB 562 will remain in the Assembly Rules Committee until further notice.

Because this is the first year of a two-year session, this action does not mean SB 562 is dead. In fact, it leaves open the exact deep discussion and debate the senators who voted for SB 562 repeatedly said is needed.

The Senate can use that time to fill the holes in SB 562 and pass and send to the Assembly workable legislation that addresses financing, delivery of care, and cost control.

The fight for single payer also is moving forward on other fronts. The head of the Campaign for a Healthy California, an organization created to pass SB 562, has acknowledged their ultimate goal is to get a single payer initiative on the ballot, and there remains ample time for them to pursue that before November 2018.

As those potential options work themselves out, the Assembly will stand with our partners to focus on the real, immediate threat to Californians' health care posed by Republicans in Washington.

Sponsor

Sponsor

SB 562 co-authors Senator Lara and Sen. Toni Atkins (D, San Diego) issued the following statement in response:

We are disappointed that the robust debate about healthcare for all that started in the California Senate will not continue in the Assembly this year. This issue is not going away, and millions of Californians are counting on their elected leaders to protect the health of their families and communities.

Continuing the push for universal healthcare has never been more critical with Congress possibly days from voting on one of the cruelest bills in our nation’s history, which will lead to millions of the poorest Americans losing insurance, soaring costs for older and sicker people, and terrible budget choices for our state.

California has the chance to lead our nation toward healthcare for all, and we will not turn our backs on this matter of life or death for families.

Sponsor


As introduced in February, SB 562 offered no funding mechanism, but was swiftly endorsed by LB Mayor Robert Garcia (who also endorsed Sen. Lara's 2018 candidacy for Insurance Commissioner.) In May, the CA State Legislative Analyst Office issued a report estimating SB 562 would cost $400 billion to cover all administrative and health care costs annually (more than the entire current state government budget) bug $200 billion of existing federal, state and local funds could be potentially shifted to go toward the single-payer system. The LAO analysis said this would leave an additional $200 billion to be raised by new taxes.

Sen. Lara and SB 562's proponents responded by producing estimates contending that the state government run system would save consumers money.

Sponsor

Sponsor

The proposed state-government run system

Although much of the discussion thus far has focused on funding, SB 562's substance -- and the impacts of the proposed state government run system on consumers and decisions affecting their health care and that of their familymembers -- also merits attention.

Nine non-elected Sacramento-appointed boardmembers -- four chosen by the Governor, plus an ex officio member working for the Governor, plus four chosen by the partisan political leadership of the party in majority control of the Assembly and state Senate -- would decide and oversee the type of health insurance offered to every man, woman and child in California (regardless of immigration status), including what the state-government run health insurance system will or won't cover at what consumer and taxpayer costs under a "single payer" system ("Healthy California") proposed by state Senator Ricardo Lara (D, Long Beach-Huntington Park) in SB 562.

SB 562 would give major decisionmaking powers to a Sacramento-chosen board similar in appointive composition to CA Coastal Commission...but not overseeing shoreline land uses but medical services for individuals and families statewide.

The board would oversee a new state government agency that would adopt rules to implement the state government insurance program and the state agency's employees would apply those policies and rules in interacting with the public.

Sponsor

In 2008, the state legislative analyst's office estimated that a "single payer" bill passed by the state legislature but vetoed by then-Governor Schwarzenegger, would have cost taxpayers over $40 billion more than then-estimated 2015-16 state revenue.

The decisionmaking Board: The bill gives the non-elected Board "all powers and duties necessary to establish and implement [a program that] shall provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state." Governor's four appointees would be subject to state Senate confirmation (effectively a partisan proceeding) and four others -- two each chosen by political partisans (the Assembly Speaker and Senate Rules Committee (meaning state Senate President Pro Tem)] would be appointed in the same current manner as the Coastal Commission members, without public hearings or public testimony or legislative questioning pro or con in public proceedings. [Disclosure: LBREPORT.com has editorially objected to these closed door practices by current and former chairs of the state Senate Rules Committee in connection with CA Coastal Commission appointees.]

The appointees "shall have demonstrated and acknowledged expertise in health care" and the Governor, Assembly Speaker and state Senate Rules Committee "shall also consider the expertise of the other members of the board and attempt to make appointments so that the board's composition reflects a diversity of expertise in the various aspects of health care."

The appointees shall consist of (a) "at least one representative of a labor organization representing registered nurses"; (b) at least one representative "of the general public"; (c) at least one representative of "a labor organization"; and (d) at least one representative of "the medical provider community." The Governor, Assembly Speaker and state Senate Rules Committee shall also "take into consideration the cultural, ethnic, and geographical diversity of the state so that the board's composition reflects the communities of California."

SB 562 gives the board "the responsibility and duty to...serve the public interest of the individuals, employers, and taxpayers seeking health care coverage through the program, and to ensure the operational well-being and fiscal solvency of the program."

(The bill also creates what it calls a "public advisory committee to advise the board on all matters of policy for the program" comprised of least 22 members with no policy setting powers.)

Privately offered/chosen health insurance nearly entirely eliminated: "A carrier may not offer benefits or cover any services for which coverage is offered to individuals under the [state government] program, but may, if otherwise authorized, offer benefits to cover health care services that are not offered to individuals under the program. However, this title does not prohibit a carrier from offering...(1) Any benefits to or for individuals, including their families, who are employed or self-employed in the state but who are not residents of the state"; or "Any benefits during the implementation period to individuals who enrolled or may enroll as members of the program."

Phasing out current insurance coverage: Within two years, the Board shall develop a "proposal, consistent with the principles of this title, for provision by the program of long-term care coverage, including the development of a proposal, consistent with the principles of this title, for its funding" and proposals for "accommodating employer retiree health benefits for people who have been members of [the state gov't program] but live as retirees out of the state" and "accommodating employer retiree health benefits for people who earned or accrued those benefits while residing in the state prior to the implementation of [the state gov't program] and live as retirees out of the state."

The Board shall also "develop a proposal for [the state gov't program] coverage of health care services currently covered under the workers' compensation system, including whether and how to continue funding for those services under that system and whether and how to incorporate an element of experience rating."

Information collected / made public: "The board shall provide for the collection and availability of all of the following data to promote transparency, assess adherence to patient care standards, compare patient outcomes, and review utilization of health care services paid for by the program:

(1) Inpatient discharge data, including acuity and risk of mortality.
(2) Emergency department and ambulatory surgery data, including charge data, length of stay, and patients' unit of observation.
(3) Hospital annual financial data, including all of the following:
(A) Community benefits by hospital in dollar value.
(B) Number of employees and classification by hospital unit.
(C) Number of hours worked by hospital unit.
(D) Employee wage information by job title and hospital unit.
(E) Number of registered nurses per staffed bed by hospital unit.
(F) Type and value of healthy information technology.
(G) Annual spending on health information technology, including purchases, upgrades, and maintenance.

(b) The board shall make all disclosed data collected under subdivision (a) publicly available and searchable through an Internet Web site and through the Office of Statewide Health Planning and Development public data sets...

Information not collected/not shared: No state or local agency, or public employee, shall provide or disclose to anyone, including the federal government "any personally identifiable information obtained, including, but not limited to, a person's religious beliefs, practices, or affiliation, national origin, ethnicity, or immigration status for law enforcement or immigration purposes." In addition, law enforcement agencies shall not use [the state gov't program] "moneys, facilities, property, equipment, or personnel to investigate, enforce, or assist in the investigation or enforcement of any criminal, civil, or administrative violation or warrant for a violation of any requirement that individuals register with the federal government or any federal agency based on religion, national origin, ethnicity, or immigration status."

Eligibility and Enrollment

"Every resident of the state shall be eligible and entitled to enroll as a member under the program. A member shall not be required to pay any fee, payment, or other charge for enrolling in or being a member under the program. A member shall not be required to pay any premium, copayment, coinsurance, deductible, and any other form of cost sharing for all covered benefits." In addition, a "college, university, or other institution of higher education in the state may purchase coverage under the program for a student, or a student's dependent, who is not a resident of the state."

What State Gov't Insurance Would Cover:

"Covered health care benefits under the program include all medical care determined to be medically appropriate by the member's health care provider." Regardless of what Congress does or doesn't do, SB 562 would maintain current coverage under "ObamaCare," covering "All essential health benefits mandated by the Affordable Care Act as of January 1, 2017."

Covered health care benefits "shall include, but are not limited to"


(1) Licensed inpatient and licensed outpatient medical and health facility services.
(2) Inpatient and outpatient professional health care provider medical services.
(3) Diagnostic imaging, laboratory services, and other diagnostic and evaluative services.
(4) Medical equipment, appliances, and assistive technology, including prosthetics, eyeglasses, and hearing aids and the repair, technical support, and customization needed for individual use.
(5) Inpatient and outpatient rehabilitative care.
(6) Emergency care services.
(7) Emergency transportation.
(8) Necessary transportation for health care services for persons with disabilities or who may qualify as low income.
(9) Child and adult immunizations and preventive care.
(10) Health and wellness education.
(11) Hospice care.
(12) Care in a skilled nursing facility.
(13) Home health care, including health care provided in an assisted living facility.
(14) Mental health services.
(15) Substance abuse treatment.
(16) Dental care.
(17) Vision care.
(18) Prescription drugs.
(19) Pediatric care.
(20) Prenatal and postnatal care.
(21) Podiatric care.
(22) Chiropractic care.
(23) Acupuncture.
(24) Therapies that are shown by the National Institutes of Health, National Center for Complementary and Integrative Health to be safe and effective.
(25) Blood and blood products.
(26) Dialysis.
(27) Adult day care.
(28) Rehabilitative and habilitative services.
(29) Ancillary health care or social services previously covered by county integrated health and human services programs pursuant to Chapter 12.96 (commencing with Section 18986.60) and Chapter 12.991 (commencing with Section 18986.86) of Part 6 of Division 9 of the Welfare and Institutions Code. (31) Case management and care coordination.
(32) Language interpretation and translation for health care services, including sign language and Braille or other services needed for individuals with communication barriers.
(33) Health care and long-term supportive services currently covered under Medi-Cal or the state's Children's Health Insurance Program (CHIP).
(34) Covered benefits for members shall also include all health care services required to be covered under any of the following provisions, without regard to whether the member would otherwise be eligible for or covered by the program or source referred to:
(A) The state's Children's Health Insurance Program (CHIP) (Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa et seq.)).
(B) Medi-Cal (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code).
(C) The federal Medicare program pursuant to Title XVIII of the Social Security Act (42 U.S.C. Sec. 1395 et seq.).
(D) Health care service plans pursuant to the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) Division 2 of the Health and Safety Code).
(E) Health insurers, as defined in Section 106 of the Insurance Code, pursuant to Part 2 (commencing with Section 10110) of Division 2 of the Insurance Code.
(F) Any additional health care services authorized to be added to the program's benefits by the program.
(G) All essential health benefits mandated by the Affordable Care Act as of January 1, 2017.

Standards

The state government system "shall establish a single standard of safe, therapeutic care for all residents of the state" by establishing "requirements and standards, by regulation, for the program and for health care organizations, care coordinators, and health care providers" including "requirements and standards for...the scope, quality, and accessibility of health care services; relations between health care organizations or health care providers and members; relations between health care organizations and health care providers, including credentialing and participation in the health care organization, and terms, methods, and rates of payment."

The Board shall also "establish requirements and standards...for replacing and merging" the state government program with "services currently provided by other programs, including, but not limited to, Medicare, the Affordable Care Act, and federally matched public health programs."

Funding

The Board "shall seek all federal waivers and other federal approvals and arrangements and submit state plan amendments as necessary to operate the program consistent with this title...The board shall apply to the United States Secretary of Health and Human Services or other appropriate federal official for all waivers of requirements, and make other arrangements, under Medicare, any federally matched public health program, the Affordable Care Act, and any other federal programs that provide federal funds for payment for health care services...To the fullest extent possible, the board shall negotiate arrangements with the federal government to ensure that federal payments are paid to Healthy California in place of federal funding of, or tax benefits for, federally matched public health programs or federal health programs."

"To enable the board to apply for coverage for, and enroll, any eligible member under any federally matched public health program or Medicare, the board may require that every member or applicant provide the information necessary to enable the board to determine whether the applicant is eligible for a federally matched public health program or for Medicare, or any program or benefit under Medicare. As a condition of continued eligibility for health care services under the [state gov't program], a member who is eligible for benefits under Medicare shall enroll in Medicare, including Parts A, B, and D."

Financing: "It is the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for the program. In developing the revenue plan, it is the intent of the Legislature to consult with appropriate officials and stakeholders."

Developing.



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