This page is part of the CalCare AB2200 Reading Group project.
https://docs.google.com/document/d/17zaR5Z3PwkFF8YIOjnZ_iXmSsa_VrVy0pqhqFbxXpiI/edit?usp=sharing
| Bill Text | Notes |
|---|---|
| LEGISLATIVE COUNSEL’S DIGEST AB 2200, as introduced, Kalra. Guaranteed Health Care for All. | assemblymember Ash Kalra |
| Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. PPACA defines a “qualified health plan” as a plan that, among other requirements, provides an essential health benefits package. Existing state law creates the California Health Benefit Exchange, also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. | PPACA = “Obamacare” For more information, see Patient Protection and Affordable Care Act Basics |
| Existing law, the Knox-Keene Health Care Service Plan Act[indexed text of law] of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care [also see Wikipedia]. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. | |
| This bill, the California Guaranteed Health Care for All Act, would create the California Guaranteed Health Care for All program, or CalCare, to provide comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all residents of the state. The bill, among other things, would provide that CalCare cover a wide range of medical benefits and other services and would incorporate the health care benefits and standards of other existing federal and state provisions, including the federal Children’s Health Insurance Program, Medi-Cal, ancillary health care or social services covered by regional centers for persons with developmental disabilities, Knox-Keene, and the federal Medicare program. The bill would make specified persons eligible to enroll as CalCare members during the implementation period, and would provide for automatic enrollment. The bill would require the board to seek all necessary waivers, approvals, and agreements to allow various existing federal health care payments to be paid to CalCare, which would then assume responsibility for all benefits and services previously paid for with those funds. | CalCare = California Guaranteed Health Care for All = Medicare For All = M4A |
| This bill would create the CalCare Board to govern CalCare, made up of 9 voting members with demonstrated and acknowledged expertise in health care, and appointed as provided, plus the Secretary of California Health and Human Services or their designee as a nonvoting, ex officio member. The bill would provide the board with all the powers and duties necessary to establish CalCare, including determining when individuals may start enrolling into CalCare, employing necessary staff, negotiating pricing for covered pharmaceuticals and medical supplies, establishing a prescription drug formulary, and negotiating and entering into necessary contracts. The bill would require the board, on or before July 1 of an unspecified year, to conduct and deliver a fiscal analysis to determine whether or not CalCare may be implemented and if revenue is more likely than not to pay for program costs, as specified. The bill would establish an Advisory Commission on Long-Term Services and Supports to advise the board on matters of policy related to long-term services and supports. The bill would require the board to convene a CalCare Public Advisory Committee to advise the board on all matters of policy for CalCare, an Advisory Committee on Public Employees’ Retirement System Health Benefits to provide recommendations related to public employee retiree health benefits, and a CalCare Health Workforce Working Group to provide the board with input on issues related to health care workforce education, recruitment, and retention. The bill would establish an Office of Health Equity within CalCare and under the direction of the Director of the Department of Health Care Access and Information to ensure health equity under the program and other health programs of the California Health and Human Services Agency and to support the board through specified actions. | Secretary of CHHS is appointed by the Governor. The entry point for marginalized communities to affect policy could be the Office of Health Equity, and also the Public Advisory Committee. Additionally, the Workforce Working Group could be influenced by POC and LGBT people. Other groups: long-term care, an advisory committee on public policy, an advisory committee on CalPERS, a working group for healthcare workers. |
| This bill would provide for the participation of health care providers in CalCare, including the requirements of a participation agreement between a health care provider and the board, provide for payment for health care items and services, and specify program participation standards. The bill would prohibit a participating provider from discriminating against a person by, among other things, reducing or denying a person’s benefits under CalCare because of a specified characteristic, status, or condition of the person. | |
| This bill would prohibit a participating provider from billing or entering into a private contract with an individual eligible for CalCare benefits regarding a covered benefit, but would authorize contracting for a health care item or service that is not a covered benefit if specified criteria are met. The bill would authorize health care providers to collectively negotiate fee-for-service rates of payment for health care items and services using a 3rd-party representative, as provided. The bill would require the board to annually determine an institutional provider’s global budget, to be used to cover operating expenses related to covered health care items and services for that fiscal year, and would authorize payments under the global budget. | jk had some confusion about this paragraph |
| This bill would state the intent of the Legislature to enact legislation that would develop a revenue plan, taking into consideration anticipated federal revenue available for CalCare. The bill would create the CalCare Trust Fund in the State Treasury, as a continuously appropriated fund, consisting of any federal and state moneys received for the purposes of the act. The bill would specify uses for moneys in the CalCare budget, including special projects for which not-for-profit or governmental entities may apply. Because the bill would create a continuously appropriated fund, it would make an appropriation. | |
| This bill would prohibit specified provisions of this act from becoming operative until the Secretary of California Health and Human Services gives written notice to the Secretary of the Senate and the Chief Clerk of the Assembly that the CalCare Trust Fund has the revenues to fund the costs of implementing the act. The California Health and Human Services Agency would be required to publish a copy of the notice on its internet website. | This a trigger that starts CalCare, when there’s sufficient funding. |
| Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. | Secrecy of meetings must be justified. |
| This bill would make legislative findings to that effect. | |
| Digest Key Vote: majority Appropriation: yes Fiscal Committee: yes Local Program: no Bill Text THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: | This means it passes if it gets a majority vote of the Asm. It requires appropriating monies. It goes through the Fiscal Committee. Local program is explained in this Capitol Weekly article. |
| SECTION 1. (a) The Legislature finds and declares all of the following: | Section 1 explains the historical context for this bill. |
| Although the federal Patient Protection and Affordable Care Act (PPACA) brought many improvements in health care and health care coverage, PPACA still leaves many Californians without coverage or with inadequate coverage. | |
| Californians, as individuals, employers, and taxpayers, have experienced a rise in the cost of health care and health care coverage in recent years, including rising premiums, deductibles, and copayments, as well as restricted provider networks and high out-of-network charges. | |
| Businesses have also experienced increases in the costs of health care benefits for their employees, and many employers are shifting a larger share of the cost of coverage to their employees or dropping coverage entirely. | |
| Individuals often find that they are deprived of affordable care and choice because of decisions by health benefit plans guided by the plan’s economic needs rather than patients’ health care needs. | |
| To address the fiscal crisis facing the health care system and the state, and to ensure Californians get the health care they need, comprehensive health care coverage needs to be provided. | |
| Billions of dollars that could be spent on providing equal access to health care are wasted on administrative costs necessary in a multipayer health care system. Resources and costs spent on administration would be dramatically reduced in a single-payer system, allowing health care professionals and hospitals to focus on patient care instead. | Reduces overhead. |
| It is the intent of the Legislature to establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state. | All residents regardless of immigration status. |
| (b) (1) It is further the intent of the Legislature to establish the California Guaranteed Health Care for All program to provide universal health care coverage for every Californian, funded by broad-based revenue. | |
| It is the intent of the Legislature to work to obtain waivers and other approvals relating to Medi-Cal, the federal Children’s Health Insurance Program, Medicare, PPACA, and any other federal programs pertaining to the provision of health care so that any federal funds and other subsidies that would otherwise be paid to the State of California, Californians, and health care providers would be paid by the federal government to the State of California and deposited in the CalCare Trust Fund. | |
| Under those waivers and approvals, those funds would be used for health care coverage that provides health care benefits equal to or exceeded by those programs as well as other program modifications, including elimination of cost sharing and insurance premiums. | |
| Those programs would be replaced and merged into CalCare, which will operate as a true single-payer program. | |
| If any necessary waivers or approvals are not obtained, it is the intent of the Legislature that the state use state plan amendments and seek waivers and approvals to maximize, and make as seamless as possible, the use of funding from federally matched public health programs and other federal health programs in CalCare. | |
| Even if other programs, including Medi-Cal or Medicare, may contribute to paying for care, it is the goal of this act that the coverage be delivered by CalCare, and, as much as possible, that the multiple sources of funding be pooled with other CalCare program funds. | |
| It is the intent of the Legislature to provide universal health care coverage with greater benefits and access to providers than existing health coverage plans, including for Californians who primarily receive care through an integrated health care delivery system, that is free at the point of service and does not have deductibles, coinsurance, premiums, or other cost-sharing. | More benefits, better than an HMO, and less money hassles. |
| (c) This act does not create an employment benefit, nor does the act require, prohibit, or limit providing a health care employment benefit. | |
| (d) (1) It is not the intent of the Legislature to change or impact in any way the role or authority of a licensing board or state agency that regulates the standards for or provision of health care and the standards for health care providers as established under current law, including the Business and Professions Code, the Health and Safety Code, the Insurance Code, and the Welfare and Institutions Code. | |
| (2) This act would in no way authorize the CalCare Board, the California Guaranteed Health Care for All program, or the Secretary of California Health and Human Services to establish or revise licensure standards for health care professionals or providers. | |
| (e) It is the intent of the Legislature that neither health information technology nor clinical practice guidelines limit the effective exercise of the professional judgment of physicians, registered nurses, and other licensed health care professionals. Physicians, registered nurses, and other licensed health care professionals shall be free to override health information technology and clinical practice guidelines if, in their professional judgment and in accordance with their scope of practice and licensure, it is in the best interest of the patient and consistent with the patient’s wishes. | Professional autonomy. This may also be related to AI. |
| (f) (1) It is the intent of the Legislature to prohibit CalCare, a state agency, a local agency, or a public employee acting under color of law from providing or disclosing to anyone, including the federal government, any personally identifiable information obtained, including a person’s religious beliefs, practices, or affiliation, national origin, ethnicity, or immigration status, for law enforcement or immigration purposes. | |
| (2) This act would also prohibit law enforcement agencies from using CalCare’s funds, facilities, property, equipment, or personnel to investigate, enforce, or assist in the investigation or enforcement of a 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, immigration status, or other protected category as recognized in the Unruh Civil Rights Act (Part 2 (commencing with Section 51) of Division 1 of the Civil Code). | Protection of patient information. This is probably motivated by immigration status. |
| (g) It is the further intent of the Legislature to address the high cost of prescription drugs and ensure they are affordable for patients. |
Question
About the finance billing and section – what is this dealing with?
Key Appealing Points
No share of cost – copays, premiums.
Reduces overhead.
All residents in the State, inclusive of immigrants and non-citizens.
All the different federal and state money goes into the CalCare Trust Fund.
Negotiates prescription drug prices.
You don’t lose your insurance when you change jobs. You have more choices in employers.
This page is part of the CalCare AB2200 Reading Group project.