California Senate Bill 562, Healthy California: An Analysis

While before being amended the bill stated that it was the Legislature’s intent “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,” the amended bill adds that “(i)t is further the intent of the Legislature to establish the Healthy California (HC) program to provide universal health coverage for every Californian based on his or her ability to pay and funded by broad-based revenue.”  Other than stating that “(i)t is the intent of the Legislature for the state to work to obtain waivers and other approvals relating to Medi-Cal, the state’s Children’s Health Insurance Program, Medicare, the PPACA, and any other federal programs 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 Healthy California Trust Fund,” no further discussion of funding is provided as amended.

The amended bill states, “Every resident of the state shall be eligible and entitled to enroll as a member under the program” and that “(c)overed health care benefits under the program include all medical care determined to be medically appropriate by the member’s health care provider.”

It lists the benefits as licensed inpatient and outpatient medical and health facility services; inpatient and outpatient professional health care provider medical services; diagnostic imaging, laboratory services, and other diagnostic and evaluative services; medical equipment, appliances, and assistive technology, including prosthetics, eyeglasses, and hearing aids and the repair, technical support, and customization needed for individual use; inpatient and outpatient rehabilitative care; emergency care services and transportation; necessary transportation for health care services for persons with disabilities or qualify as low income; child and adult immunizations and preventive care; health and wellness education; hospice care; care in a skilled nursing facility; home health care or provided in an assisted living facility; mental health services; substance abuse treatment; dental, vision, pediatric, prenatal, postnatal, podiatric and  chiropractic care; prescription drugs; and acupuncture.

Additionally it lists therapies that are shown by the National Institutes of Health, National Center for Complementary and Integrative Health to be safe and effective; blood and blood products; dialysis; adult day care; rehabilitative and “habilitative (sic)” services; ancillary health care or social services previously covered by county integrated health and human services programs; ancillary health care or social services previously covered by a regional center for persons with developmental disabilities; case management and care coordination; language interpretation and translation for health care services, including sign language and Braille or other services needed for people with communication barriers; health care and long-term supportive services now covered by Medi-Cal or the state’s Children’s Health Insurance Program (CHIP); covered benefits for members shall also include all health care services required to be covered under any of the following provisions: the state’s CHIP, Medi-Cal, the federal Medicare program, health care service plans pursuant to the Knox-Keene Health Care Service Plan Act of 1975, health insurers, as defined in Section 106 of the Insurance Code, any additional health care services authorized to be added to the program’s benefits by the program and all essential health benefits mandated by the Affordable Care Act as of January 1, 2017.

Regarding governance, the amended bill will create an independent 9-member board to govern the “Healthy California” program.  The nine members are all appointed.  The California governor will appoint four, which the Senate must confirm.  The Senate Rules Committee will appoint two.  The Assembly Speaker will appoint two.  The California Health and Human Services Secretary, who the California governor also appoints, will serve as an ex-officio member and his or her appointee will have a vote.  All are appointed for four years except for the ex officio member.  Regarding the appointments, the amended bill states that each appointee “shall have demonstrated acknowledged expertise in health care,” that the “(a)ppointing 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, and that among the appointees that “(a)t least one representative (be) of a labor organization representing registered nurses,” that “(a)t least one representative (be) of the general public,” that “(a)t least one representative (be) of a labor organization” and “(a)t least one representative of the medical provider community.”

Besides the amended bill stating that the 9-appointed-member board will govern the program, the amended bill states, “The Secretary of California Health and Human Services shall establish a public advisory committee to advise the board on all matters of policy for the program.”

The amended bill also states that “any state or local agency, or a public employee acting under color of law shall not provide or disclose to anyone, including, but not limited to, 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” and that “law enforcement agencies shall not use Healthy California 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.”

The amended bill defines a carrier as “either a private health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner or a health care service plan, as defined under subdivision (f) of Section 1345 of the Health and Safety Code, licensed by the Department of Managed Health Care”and states, “(a)carrier may not offer benefits or cover any services for which coverage is offered to individuals under the program, but may, if otherwise authorized, offer benefits to cover health care services that are not offered to individuals under the program.”

The text of the amended bill may be found here.