Comparison of California Health Care Reform Proposals from ...



Comparison of California Health Care Reform Proposals from the 2007-08 Legislative Session

| |ABX1 1 (Nuñez) |AB 8 (Nuñez) |SB 840 (Kuehl) |ABX1 8 (Villines) |CalCare Plus |

| |As amended in special session on |As passed by the Legislature |As passed by the Legislature |As introduced in special |Package of bills introduced in |

| |1/16/2008 |9/10/07 and vetoed by the |and vetoed by the Governor on |session 11/6/07 |special session 10/11/07 by |

| | |Governor 12/12/07 |9/30/2008 | |Senate Republicans |

|Californians to be |Estimated 3.6 million (about 70 |Estimated 3.4 million (more |All California residents |No estimate |No estimate |

|covered |percent of uninsured Californians) |than two-thirds of uninsured |(physical presence in the state| | |

| | |Californians at a given point |with intent to reside) | | |

| | |in time) | | | |

|Employer requirements |Employers would be required to pay a |Employers would be required to |Employers would be required to |Tax credit for certain |Incentives to establish Section|

|and incentives |sliding scale of 1 to 6.5 percent of |pay 7.5 percent of Social |pay a payroll tax of 8.17 |categories of employers that |125 plans and to make HSA |

| |Social Security wages depending on |Security wages for employee |percent to fund coverage under |offer high deductible health |contributions. |

| |payroll size, for employee health |health care expenditures or pay|the single payer system. |plans (HDHP) and health savings| |

| |care expenditures or pay an |an equivalent amount into a | |accounts (HSA) to employees. |Incentives to offer health |

| |equivalent amount into a trust fund |trust fund to allow employees |Employers could provide | |insurance with flex-time work |

| |to allow employees to access coverage|to access coverage through a |additional coverage to workers | |schedules for employees |

| |though a state purchasing pool. |state purchasing pool. |to supplement coverage provided| | |

| | | |under the single payer system. | | |

| | |All employers would be required| | | |

| | |to establish Section 125 plans | | | |

| | |to shelter from income and | | | |

| | |payroll taxes employer and | | | |

| | |employee health insurance | | | |

| | |contributions. | | | |

|Individual |Would require all Californians and |Would require employees working|Would deem all California |None. |None. |

|requirements |their dependents living in California|for an employer that offers |residents as eligible for | | |

| |longer than six months to have |health coverage to accept that |coverage. | | |

| |“minimum creditable coverage,” as |coverage, unless the employee | | | |

| |determined by the Managed Risk |has evidence of other coverage,| | | |

| |Medical Insurance Board (MRMIB). |or his or her share of coverage| | | |

| |Exemptions from the minimum coverage |costs exceeds 5 percent of | | | |

| |requirements would apply to |family income (in households | | | |

| |individuals with an income below 250 |with family income less than | | | |

| |percent of the federal poverty level |300 percent of the FPL. | | | |

| |(FPL), whose total cost of coverage | | | | |

| |exceeds 5 percent of family income, |Would require employees working| | | |

| |and to individuals with a case of |for an employer that opts to | | | |

| |serious hardship, as determined by |pay fees, rather than offer | | | |

| |MRMIB. |coverage, to enroll in, and | | | |

| | |obtain coverage through, a | | | |

| | |state purchasing pool. | | | |

|Purchasing pool |Would establish the California |Would establish the California |Would establish the California |Would establish a California |Not applicable. |

| |Cooperative Health Insurance |Cooperative Health Insurance |Health Insurance System (CHIS) |Health Insurance Exchange to | |

| |Purchasing Program (Cal-CHIPP), |Purchasing Program (Cal-CHIPP),|as a statewide purchasing |support employers and employees| |

| |administered by MRMIB, to negotiate |administered by MRMIB, to |entity to negotiate and pay for|with cafeteria plans. | |

| |and purchase health insurance for |negotiate and purchase health |all covered benefits. | | |

| |eligible enrollees. |insurance for eligible | | | |

| | |enrollees. | | | |

|Public program changes|Would expand Healthy Families |Would expand Healthy Families |Would consolidate existing |Envisions a program to allow |Would reallocate First Five |

| |coverage to children in families with|coverage to children in |funding for public programs |low-income Medi-Cal |funds, subject to voter |

| |incomes up to 300 percent of the FPL,|families with incomes up to 300|into one fund to provide |beneficiaries to enroll in |approval, for children’s health|

| |regardless of immigration status. |percent of the FPL, regardless |coverage under the proposed |state-financed accounts, |care. |

| | |of immigration status. |single payer system. |similar to HSAs, to purchase | |

| |Would expand Medi-Cal coverage to | | |health insurance in the private| |

| |parents and caretaker relatives in |Would expand Medi-Cal coverage | |sector. | |

| |families with incomes up to 250 |to parents and caretaker | | | |

| |percent of the FPL through benchmark |relatives in families with | | | |

| |plans offered through Cal-CHIPP. |incomes up to 250 percent of | | | |

| | |the FPL through benchmark plans| | | |

| |Would expand Medi-Cal coverage to |offered through Cal-CHIPP. | | | |

| |childless adults with incomes up to | | | | |

| |250 percent of the FPL. |Would establish uniform | | | |

| |Would expand Medi-Cal coverage to |eligibility standards, and | | | |

| |adults ages 19 and 20 earning less |simplify Medi-Cal and Healthy | | | |

| |than 250 percent of the FPL through |Families enrollment for all | | | |

| |benchmark plans offered through |children. | | | |

| |Cal-CHIPP. | | | | |

|Insurance market |Would require all health plans to |Would require all health plans |Would prohibit the sale of any |Would encourage greater |Would encourage greater |

|reforms |guarantee issue, simplify medical |to guarantee issue and use |private health insurance |availability of HSAs and HDHPs.|availability of HSAs and HDHPs.|

| |underwriting, including the use of a |community rating in the |policy, other than CHIS, but | | |

| |standardized application form, and |individual market for |would permit insurers to sell |Would allow plans sold in other|Would allow plans sold in other|

| |offer five classes of benefits to |individuals without serious |supplemental policies for |states to be available in |states to be available in |

| |facilitate comparison shopping. |medical conditions. |benefits not covered by CHIS. |California without approval |California without approval |

| | | | |from the Department of Managed |from the Department of Managed |

| |Would require health plans to spend |Would require simplified | |Health Care (DMHC) or the |Health Care (DMHC) or the |

| |85 percent of premiums on patient |medical underwriting, including| |Department of Insurance (CDI). |Department of Insurance (CDI). |

| |care. |a standardized individual | | | |

| | |application form, and require | |Would allow coverage products |Would require Cal-PERS to offer|

| |Would require health plans and |all health plans to offer three| |that do not include state |HSAs and HDHPs to state |

| |insurers to charge premiums for |uniform benefit designs to | |mandated benefits, and would |employees. |

| |individual health plan contracts and |facilitate comparison shopping.| |require the California Public | |

| |policies that reflect standard risk | | |Employees Retirement System |Would permit greater rate |

| |rates based on established age, |Would require health plans to | |(Cal-PERS) to offer HSAs as an |flexibility in the small group |

| |family size, and geographic region |spend 85 percent of premiums on| |option to state employees. |market, and would allow |

| |rating categories. |patient care. | | |hospitals to offer coverage for|

| | | | | |preventive services only where |

| | |Would apply rules currently | | |care is delivered through a |

| | |regulating the small group | | |hospital's primary care clinic |

| | |market to the mid-sized | | |or a community-based clinic. |

| | |employer market. | | | |

|State tax provisions |Individuals with incomes between 250 |Through requirement on |Through SB 1014 (Kuehl), a |Would provide individuals with |Would provide that state tax |

| |and 400 percent of the FPL, who are |employers to establish Section |companion measure to SB 840, |a tax deduction for the |law conform with federal law on|

| |not offered coverage by their |125 plans, employers and |this proposal would impose a |purchase of health coverage, as|HSAs, provide tax credits to |

| |employer, and who are not eligible |employees would be able to make|payroll tax, as well as income |well as tax credits for |employers who contribute to |

| |for public coverage programs, would |tax-sheltered health care |taxes, at various levels |employers who offer HDHPs and |their employees’ HSAs, and |

| |receive an advanceable, refundable |contributions. |depending on income levels, for|HSAs to their employees, and |offer tax incentives for |

| |tax credit to purchase health | |the purpose of funding the |who use the Health Information |employers to offer Section 125 |

| |coverage. | |single payer system. |Exchange for cafeteria plans. |plans. |

| | | | | | |

| | | | |Would establish a tax credit |Would provide hospitals and |

| | | | |for providers in an amount of |physicians with a tax credit to|

| | | | |50 percent of the cost of |purchase health information |

| | | | |uncompensated care for |technology. |

| | | | |uninsured patients. | |

| | | | | |Would provide tax credits to |

| | | | | |primary care providers who |

| | | | | |practice in rural areas, and |

| | | | | |would establish a tax credit |

| | | | | |for providers in an amount of |

| | | | | |50 percent of the cost of |

| | | | | |uncompensated care for |

| | | | | |uninsured patients. |

|Cost containment |Would establish community makeover |Would establish uniform benefit|Would implement evidence-based |Would emphasize increase use of|Would expand clinics to be used|

|provisions |grants for obesity prevention and |packages for primary and |medicine and system-wide |HDHPs and HSAs, and would |to provide primary care |

| |other prevention programs, and would |preventive care with minimal |standards of care, based on |provide a broader range of |services in lieu of higher cost|

| |require all health plans to offer |patient cost sharing. |clinical efficacy. |benefit options to facilitate |delivery systems such as |

| |“Healthy Action” plans with benefits | | |consumer choice, including |emergency rooms. |

| |designed to promote wellness. |Would establish a new |Would establish a system-wide |allowing plans sold in other | |

| | |commission dedicated to |approach to addressing medical |states to be sold in California|Would encourage greater |

| |Would establish a new commission |enhancing health care cost and |errors, and would establish an |without approval from DMHC or |availability of benefit options|

| |dedicated to creating a state plan on|quality transparency. |Office of Health Care Quality, |CDI, allow coverage products |by requiring DMHC and CDI to |

| |health care cost and quality | |charged with measuring, |that do not include |approve more coverage products,|

| |transparency. |Would require health plans to |monitoring, and improving |state-mandated benefits, and |require CalPERS to offer HDHPs |

| | |spend 85 percent of premiums on|quality. |state tax conformity on HSAs. |and HSAs to state employers, |

| |Would require health plans to spend |patient care, and require | | |provide greater rate |

| |85 percent of premiums on patient |specified health plans to |Would achieve savings by bulk | |flexibility in the small group |

| |care. |implement preventive services. |purchasing of prescription | |market, and encourage use of |

| | | |drugs and durable medical | |HDHPs and HSAs. |

| |Would modify health care professional|Would promote the |equipment. | | |

| |scopes of practice, promote personal |implementation of personal | | |Would establish low-interest |

| |health records in CalPERS, and impose|health records, and would |Would authorize wide cost | |loans for health providers to |

| |e-prescribing requirements in |require an assessment of new |control measures, including | |acquire health information |

| |specified providers. |health technology. |benefit reductions, when | |technology, and would repeal |

| | | |statewide trends indicate the | |the current prohibition against|

| | |Would require MRMIB to |need for cost reductions. | |direct employment of doctors by|

| | |negotiate with Medi-Cal managed| | |hospitals. |

| | |care plans. | | | |

|Financing Sources |Through a voter-approved initiative, |Would finance costs through |Costs would be financed through|Would require large conversion |Would reallocate funds provided|

| |financing would come from a variety |employer and employee |new taxes imposed upon |foundations to spend 90 percent|to Disproportional Share |

| |of sources including contributions |contributions, and additional |individuals and employers. |of annual expenditures on |Hospitals (DSH) to create and |

| |from employees, employees, |federal funds. | |health services for citizens |expand primary care clinics. |

| |individuals, and counties, as well as| | |who are not eligible for | |

| |hospital fees, and an increase in the| | |coverage through local, state, |Would realign Medi-Cal benefits|

| |tobacco tax of $1.75 per pack. | | |or federal programs. |with private benefits for cost |

| | | | | |savings. |

| |The measure would also bring in | | | | |

| |additional federal funds. | | | |Would reallocate $500 million |

| | | | | |from First Five Commission to |

| | | | | |pay for children’s health care.|

| | | | | | |

| | | | | |Would request that the federal |

| | | | | |government pay unreimbursed |

| | | | | |costs for providing health care|

| | | | | |services to undocumented |

| | | | | |immigrants. |

Sources: California Health Care Foundation, Senate Health Committee, Senate Office of Research, and Assembly Health Committee analyses.

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