How California’s New Health Care Laws Will Affect You, From Vaccines to Premiums

October 22, 2019

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Source: The Sacramento Bee

Now that California legislators and Gov. Gavin Newsom are done making new laws for the year, here’s a look at how the policies they created will affect your health care.

They fall short of the universal health care Newsom campaigned on, but many of the new laws are aimed at getting more people insured, cutting costs and making it harder to forego vaccines and insurance.

Vaccine requirements

It will be harder for California parents to avoid vaccinating their kids. New rules cracking down on medical exemptions for childhood vaccines require the state to investigate doctors who give out more than five exemptions in a year and schools with immunization rates under 95 percent.

The author of the new vaccine laws, Sen. Richard Pan, D-Sacramento, argues they are necessary to prevent fraudulent exemptions some doctors are selling to families of children who should be vaccinated. The measures build on a 2015 law that prevents parents from skipping vaccines for their kids based solely on their personal beliefs. Students without exemptions must be vaccinated to attend school in California.

The new vaccine rules prompted raucous protests at the Capitol that culminated in an anti-vaccine demonstrator dropping a menstrual cup filled with blood on lawmakers in the Senate chamber.

Potentially lower health costs

Californians could see lower prices for insurance and prescription drugs, if new laws work as intended.

Newsom signed a high profile bill over opposition from pharmaceutical companies that aims to crack down on a practice known as “pay for delay,” when one pharmaceutical company pays another to delay the release of a lower-cost generic equivalent of a brand-name drug.

Assembly Bill 824 forces drug companies to prove they aren’t engaging in anti-competitive behavior when they strike deals with generics companies, a move intended to make “pay for delay” cases easier to prosecute.

The drug companies argue that the new law will have unintended consequences and prevent deals between companies that allow generic versions of drugs to be sold before an original drug’s patent expires.

Newsom also signed two new laws aimed at increasing public oversight of insurance plans, Assembly Bills 929 and 731, which supporters argue will drive down insurance costs. The insurance plans opposed both new laws, arguing they will place a costly burden on the health plans and jeopardize patient data.

New rules for kidney patient care

Supporters say another new law capping payment rates for dialysis treatment will lower insurance costs, but opponents argue it will prevent kidney patients from accessing needed care.

Late-stage kidney-failure patients in the United States are eligible for government health insurance to cover their dialysis treatment, which filters blood for people whose kidneys have stopped working. Some low-income dialysis patients who qualify through Medi-Cal can have all of their treatment costs covered by the government.

The nonprofit American Kidney Fund, which pays medical expenses for some kidney patients and is funded by dialysis companies, has been accused of steering patients to private insurance plans with higher payment rates for the dialysis companies.

Having to cover high-cost dialysis patients causes private insurance companies to raise rates for everyone, argues the new law’s author, Assemblyman Jim Wood.

His legislation will cap payment rates for the dialysis companies in situations where a third-party like the American Kidney Fund is paying a patient’s premiums. It will also affect drug addiction treatment centers.

American Kidney Fund President LaVarne Burton announced Sunday evening shortly after Newsom signed that bill that the charity would pull funding for all California dialysis patients Jan. 1 in response to the new law.

The nonprofit says it pays medical bills for about 3,700 kidney patients in California.

In a signing statement, Newsom said he approved the new law to curb rising health care costs and urged charities like the American Kidney Fund not to cut aid for California patients.

“Charities that purport to impartially provide patient assistance, and the providers that substantially fund these charities, should act in good faith and continue providing assistance,” he wrote.

More time to sign up for insurance

Californians who purchase insurance plans through the Covered California marketplace will have two more weeks to enroll in health coverage next year.

A new law Newsom signed Sunday will extend the enrollment deadline from January 15 to January 31 in an effort to make it easier for people to sign up for insurance.

The enrollment period to sign up for 2020 insurance begins Oct. 15.

Fines for the uninsured

Other Californians will have to pay fines for not having health insurance. The budget Newsom signed in June includes an “individual mandate,” modeled on the one in the Affordable Care Act that requires people to buy coverage or pay a penalty. In 2016, the penalty was $695 per adult or 2.5 percent of yearly household income, whichever was higher.

That part of “Obamacare” has since been rolled back at the federal level. The California version of the mandate is estimated to raise about $1 billion over three years and will help fund health insurance subsidies for middle-income people.

People who fall below a certain income threshold will be exempt from paying the fine.

Premium cost assistance

Middle-income Californians have new help paying their premiums under the state budget Newsom signed in June. It includes nearly $1.5 billion in state health care subsidies for plans purchased through the state’s Covered California insurance marketplace. Most of that money will go to people making four to six times the federal poverty level, which is about $103,000 to $154,000 for a family of four.

People making between 200 and 400 percent of the poverty level will also receive state subsidies on top of the federal assistance they already receive.

Californians can see if they will likely qualify for the new subsidies through the Covered California website, coveredca.com.

Undocumented immigrant care

Undocumented immigrants under age 26 can sign up for state’s low-income health insurance program starting Jan. 1 under the state budget Newsom signed in June. To qualify, they will need to make less than 138 percent of the federal poverty level, which is about $17,200 or $35,500 for a family of four.

Undocumented children were already eligible for the program.

 

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