(March 31, 2017) -- 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.
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The newly-amended (Mar. 29) SB 562 text (now joined as co-authors by Senators Galgiani, McGuire, and Skinner and Assemblymembers Bonta, Chiu, Friedman, Nazarian, and Thurmond) gives 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. The latest version of SB 562 leaves unclear how most of the state government insurance system would be funded. As previously reported by LBREPORT.com, the state legislative analyst's office previously estimated that a "single payer" bill, passed in 2008 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. On March 22 [before SB 562's more substantive text was made public], Governor Brown said in a SacBee.com reported chat with reporters: "Where do you get the extra money?...This is the whole question. I don't even get ... how do you do that?" He added, "This is called 'the unknown by means of the more unknown,'...In other words, you take a problem, and say ‘I am going to solve it by something that’s ... a bigger problem,’ which makes no sense."
Some (including Long Beach Mayor Robert Garcia) endorsed SB 562 in mid-February 2017 without knowing its details. (Sen. Lara introduced the bill without substantive provisions before publicizing the fact that he'd already filed paperwork to run for State Insurance Commissioner in 2018, which Garcia has also endorsed.) LBREPORT.com reports SB 562's details below, quoting from the bill text itself.
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. 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"
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. blog comments powered by Disqus Recommend LBREPORT.com to your Facebook friends:
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